Healthcare Provider Details

I. General information

NPI: 1972284206
Provider Name (Legal Business Name): REBA WUNDERLICH AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S WASHBURN ST
OSHKOSH WI
54904-7975
US

IV. Provider business mailing address

119 E BELL ST
NEENAH WI
54956-4993
US

V. Phone/Fax

Practice location:
  • Phone: 920-969-1768
  • Fax: 920-267-5222
Mailing address:
  • Phone: 920-969-1768
  • Fax: 920-267-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1035-156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: