Healthcare Provider Details

I. General information

NPI: 1013830546
Provider Name (Legal Business Name): ONESWALLOW DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 AUGUSTA DR
WAUNAKEE WI
53597-2242
US

IV. Provider business mailing address

604 AUGUSTA DR
WAUNAKEE WI
53597-2242
US

V. Phone/Fax

Practice location:
  • Phone: 608-347-2368
  • Fax: 608-347-2368
Mailing address:
  • Phone: 608-347-2368
  • Fax: 608-347-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. SARA E GUSTAFSON
Title or Position: CO-FOUNDER
Credential: MS, SLP
Phone: 608-347-2368