| NPI | 1427195304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY JOHN PROVENCHER President 262-377-8350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WI 1504-154) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 4146-024) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2025-09-11 |