Healthcare Provider Details

I. General information

NPI: 1790607703
Provider Name (Legal Business Name): GRACE ELIZABETH WHELAN TWEEDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6271 WOODLAND DR
WAUNAKEE WI
53597-9256
US

IV. Provider business mailing address

6271 WOODLAND DR
WAUNAKEE WI
53597-9256
US

V. Phone/Fax

Practice location:
  • Phone: 608-849-2030
  • Fax:
Mailing address:
  • Phone:
  • 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: