Individual
LOLA BRIDGET DEFEVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CF-SLP
Contact information
Practice address
2300 WESTERN AVE, MANITOWOC, WI 54220-3712
(262) 804-7554
Mailing address
1000 RIVER POINT DR APT 510, MANITOWOC, WI 54220-5675
(262) 804-7554
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6270-154
WI
Other
Enumeration date
07/05/2023
Last updated
07/05/2023
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