Provider Demographics
NPI:1164463527
Name:INGWERSEN, DANA MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:INGWERSEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5453 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5103
Mailing Address - Country:US
Mailing Address - Phone:414-477-9985
Mailing Address - Fax:
Practice Address - Street 1:741 S BENEVA RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2411
Practice Address - Country:US
Practice Address - Phone:941-957-0310
Practice Address - Fax:941-365-7324
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA19709235Z00000X
WI966-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42568000Medicaid