Healthcare Provider Details

I. General information

NPI: 1639746571
Provider Name (Legal Business Name): REBECCA ALYSE WILLER MS, CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E RAWSON AVE STE 317
OAK CREEK WI
53154-1525
US

IV. Provider business mailing address

2209 1ST CIR
KENOSHA WI
53140-1053
US

V. Phone/Fax

Practice location:
  • Phone: 262-287-0090
  • Fax:
Mailing address:
  • Phone: 262-455-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5251-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: