Provider Demographics
NPI:1689337289
Name:WINDELL, DEANN LEAH
Entity Type:Individual
Prefix:
First Name:DEANN
Middle Name:LEAH
Last Name:WINDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEANN
Other - Middle Name:
Other - Last Name:GUSTAFSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W1667 COUNTY RD N
Mailing Address - Street 2:
Mailing Address - City:NIAGARA
Mailing Address - State:WI
Mailing Address - Zip Code:54151-9290
Mailing Address - Country:US
Mailing Address - Phone:906-282-4596
Mailing Address - Fax:
Practice Address - Street 1:5778 CHAPIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:WI
Practice Address - Zip Code:54121-9443
Practice Address - Country:US
Practice Address - Phone:715-528-4833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2192-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant