Healthcare Provider Details

I. General information

NPI: 1386573855
Provider Name (Legal Business Name): ABBY MARIE WUNDROW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S CLARK ST
THORP WI
54771-9660
US

IV. Provider business mailing address

605 S CLARK ST
THORP WI
54771-9660
US

V. Phone/Fax

Practice location:
  • Phone: 715-669-5548
  • Fax: 715-669-3701
Mailing address:
  • Phone: 715-669-5548
  • Fax: 715-669-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: