Healthcare Provider Details

I. General information

NPI: 1285544650
Provider Name (Legal Business Name): BREA FALSTAD M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MEADOWOOD DR
RANDOLPH WI
53956-1318
US

IV. Provider business mailing address

202 S MAIN ST
PARDEEVILLE WI
53954-9116
US

V. Phone/Fax

Practice location:
  • Phone: 920-326-2431
  • Fax:
Mailing address:
  • Phone: 608-617-1850
  • 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: