Healthcare Provider Details

I. General information

NPI: 1699682500
Provider Name (Legal Business Name): ASHLELY RAE ANDERSON MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SCHOOL ST
LODI WI
53555-1046
US

IV. Provider business mailing address

110 COBBLESTONE DR
LODI WI
53555-1421
US

V. Phone/Fax

Practice location:
  • Phone: 608-852-6469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: