Provider Demographics
NPI:1194003863
Name:DESAI, ANNA C (MA PC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:C
Last Name:DESAI
Suffix:
Gender:F
Credentials:MA PC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:C
Other - Last Name:AUFDERHAAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11101 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1133
Mailing Address - Country:US
Mailing Address - Phone:920-650-5065
Mailing Address - Fax:
Practice Address - Street 1:11101 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1133
Practice Address - Country:US
Practice Address - Phone:414-203-4515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4740-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional