Andrea Kay Bolstad, M.S. CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · De Forest, WI
NPI 1841497922 · NPPES record last updated Jun 11, 2009
Key facts
- NPI
- 1841497922
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 2362-154 (WI)
- Practice address
- 725 Columbia Ave
De Forest, WI 53532-1333 - Phone
- (303) 929-2528
- NPI assigned
- Jul 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2362-154 | WI | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2362-154 | WI | Yes |
Addresses
Primary practice location
725 Columbia Ave
De Forest, WI 53532-1333
Mailing address
725 Columbia Ave
De Forest, WI 53532-1333
Phone (303) 929-2528
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42797600 | Medicaid | WI |
Other providers in De Forest, WI
- Back to Health Plus, PLLC
- Meredith Hughes Bakke
- John T Bayer
- Christina Gale Bensche
- Megan Blount
- Bonita Lorraine Brossard
- Renee Eve Brunner
- Carla Budrow
- Rebecca Sue Burke
- Darcy Lee Coddington
All providers in De Forest, WI · Speech-Language Pathologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.