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Individual

MRS. LANA MARIE EDWARDS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS CCCSLP

Contact information

Practice address
626 EAST SLIFER STREET, PORTAGE, WI 53901
(608) 742-8814
(608) 742-2384
Mailing address
PO BOX 564, 626 EAST SLIFER STREET, PORTAGE, WI 53901
(608) 742-8814
(608) 742-2384

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2127154
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
42787700
WI
Enumeration date
02/08/2008
Last updated
02/08/2008
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