Healthcare Provider Details

I. General information

NPI: 1104759745
Provider Name (Legal Business Name): WENDI UPTHAGROVE MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 WILMOT AVE
TWIN LAKES WI
53181-9419
US

IV. Provider business mailing address

1218 WILMOT AVE
TWIN LAKES WI
53181-9419
US

V. Phone/Fax

Practice location:
  • Phone: 262-877-2148
  • Fax:
Mailing address:
  • Phone: 262-877-2148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1001073196
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: