Healthcare Provider Details

I. General information

NPI: 1164268843
Provider Name (Legal Business Name): ANNA RYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MAIN ST
EAU CLAIRE WI
54701-3770
US

IV. Provider business mailing address

940 HONEY BEAR LN
WAUPACA WI
54981-1074
US

V. Phone/Fax

Practice location:
  • Phone: 715-852-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6638-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: