Healthcare Provider Details

I. General information

NPI: 1891903506
Provider Name (Legal Business Name): ADAM EDWARD VANRANST MS-CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 DAVIS ST
HAMMOND WI
54015-9615
US

IV. Provider business mailing address

1090 7TH AVE
BALDWIN WI
54002-9223
US

V. Phone/Fax

Practice location:
  • Phone: 715-796-2218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2470154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: