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General NPI Number Information
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NPI Number | 1659281822
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Entity Type | Organization
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Legal Business Name | COUNTRYSIDE COMMUNICATION CLINIC, LLC
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | S1510 WEGNER RD
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City | LA VALLE
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State | WI
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Zip | 53941-9309
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Country | US
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Telephone | 608-630-4694
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Fax | 608-608-8414
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Provider Business Mailing Address
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Address Line | S1510 WEGNER RD
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City | LA VALLE
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State | WI
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Zip | 53941-9309
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Country | US
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Telephone | 608-630-4694
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Fax | 608-608-8414
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | KEELY COMMUNICATION BAUER
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Credential | MS, CCC-SLP
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Telephone | 608-630-4694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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