MEDICARE: DR. ANNE L SHANDERA-OCHSNER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	6206	MN
2	103G00000X	Clinical Neuropsychologist	3287	WI
3	103G00000X	Clinical Neuropsychologist	PY 9170	FL
4	103TC0700X	Clinical Psychologist	3287	WI

General Provider Information

NPI Number	:	1972989804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE L SHANDERA-OCHSNER PH.D.

Provider Business Mailing Address
First Line	:	200 1ST ST SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55905-0001
Country	:	US
Telephone Number	:	608-785-0940
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 S MAIN ST
Second Line	:
City	:	HOLMEN
State	:	WI
Zip	:	54636-8927
Country	:	US
Telephone Number	:	608-785-0940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2015
Last Update Date	:	06/20/2025

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