Provider Demographics
NPI:1376700146
Name:SANTELLE, ANNA MARIA (MA CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIA
Last Name:SANTELLE
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:MARIA
Other - Last Name:RICHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCCSLP
Mailing Address - Street 1:5931 82ND PLACE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142
Mailing Address - Country:US
Mailing Address - Phone:262-694-6560
Mailing Address - Fax:
Practice Address - Street 1:3100 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144
Practice Address - Country:US
Practice Address - Phone:262-658-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI417154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42720600Medicaid