Provider Demographics
NPI:1609041870
Name:MCKIERNAN, ANN
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:MCKIERNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 WILDERNESS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-8357
Mailing Address - Country:US
Mailing Address - Phone:715-389-6000
Mailing Address - Fax:715-389-6090
Practice Address - Street 1:209 WILDERNESS VIEW DR
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-8357
Practice Address - Country:US
Practice Address - Phone:715-389-6000
Practice Address - Fax:715-389-6090
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2203-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42783400Medicaid