Healthcare Provider Details

I. General information

NPI: 1083353783
Provider Name (Legal Business Name): TAYLOR R HABERMANN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E BURNETT ST
BEAVER DAM WI
53916-1902
US

IV. Provider business mailing address

400 E BURNETT ST
BEAVER DAM WI
53916-1902
US

V. Phone/Fax

Practice location:
  • Phone: 920-885-7300
  • Fax:
Mailing address:
  • Phone: 920-885-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14393537
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: