Provider Demographics
NPI:1194824128
Name:KANE, ANDREA (SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:WI
Mailing Address - Zip Code:54023-9715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2705 ENLOE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8173
Practice Address - Country:US
Practice Address - Phone:715-386-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7716235Z00000X
WI2920235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN28B1AROtherBCBS MN
MN423T5AROtherBLUE CROSS BLUE SHIELD
MNHP45694OtherHEALTH PARTNERS
167861OtherAETNA
641671046996OtherPREFERED ONE
WI42583700Medicaid
46010108OtherMEDICA
MN246533Medicare ID - Type UnspecifiedHEALTH DIMENSIONS REHAB