Provider Demographics
NPI:1851303630
Name:FEDERMAN, ANDREA L (AUD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:FEDERMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:BUETTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:119 E BELL ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4993
Mailing Address - Country:US
Mailing Address - Phone:920-969-1768
Mailing Address - Fax:920-267-5222
Practice Address - Street 1:119 E BELL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4993
Practice Address - Country:US
Practice Address - Phone:920-969-1768
Practice Address - Fax:920-267-5222
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI299231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41134600Medicaid
S41438Medicare UPIN
WI41134600Medicaid