Individual
ANDREA KAY BOLSTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
725 COLUMBIA AVE, DE FOREST, WI 53532-1333
(303) 929-2528
Mailing address
725 COLUMBIA AVE, DE FOREST, WI 53532-1333
(303) 929-2528
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2362-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42797600
—
WI
Enumeration date
07/02/2007
Last updated
06/11/2009
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