Provider Demographics
NPI:1255325205
Name:WORRELL, DEIRDRE ANN (MS)
Entity Type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:ANN
Last Name:WORRELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 NORTH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1879
Mailing Address - Country:US
Mailing Address - Phone:715-386-1760
Mailing Address - Fax:
Practice Address - Street 1:1516 NORTH RIDGE DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1879
Practice Address - Country:US
Practice Address - Phone:715-386-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI454-156231H00000X
WI938-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41149300Medicaid
WI42567800Medicaid
WI41149300Medicaid