Provider Demographics
NPI:1346314341
Name:ORHEIM, GWEN ELLEN (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:ELLEN
Last Name:ORHEIM
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:MISS
Other - First Name:GWEN
Other - Middle Name:ELLEN
Other - Last Name:HOVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCCSLP
Mailing Address - Street 1:10500 W LOOMIS RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8111
Mailing Address - Country:US
Mailing Address - Phone:414-858-9223
Mailing Address - Fax:414-858-1017
Practice Address - Street 1:10500 W LOOMIS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8111
Practice Address - Country:US
Practice Address - Phone:414-858-9223
Practice Address - Fax:414-858-1017
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1491-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI01109878OtherASHA
WI425-886-00Medicaid
WI1491-154OtherSTATE LICENSURE