Provider Demographics
NPI:1083888630
Name:BOHRER, DANA SUE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:SUE
Last Name:BOHRER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 CATHEDRAL POINT DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-8520
Mailing Address - Country:US
Mailing Address - Phone:608-556-6120
Mailing Address - Fax:
Practice Address - Street 1:1270 CATHEDRAL POINT DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-8520
Practice Address - Country:US
Practice Address - Phone:608-556-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2800-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2800-154OtherSTATE OF WISCONSIN LICENS