Provider Demographics
NPI:1346395134
Name:MUTHIAH, SIVANANDHINI (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:SIVANANDHINI
Middle Name:
Last Name:MUTHIAH
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 E CARDINAL PLACE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915
Mailing Address - Country:US
Mailing Address - Phone:920-749-0461
Mailing Address - Fax:
Practice Address - Street 1:443 MANHATTAN ST
Practice Address - Street 2:NEW HOPE CENTER INC
Practice Address - City:CHILTON
Practice Address - State:WI
Practice Address - Zip Code:53014
Practice Address - Country:US
Practice Address - Phone:920-849-9351
Practice Address - Fax:920-849-7792
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1864154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42786300Medicaid