Provider Demographics
NPI:1851599351
Name:ANGER CULLITON, CAROL ANN (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:ANGER CULLITON
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 HOOVER AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4426
Mailing Address - Country:US
Mailing Address - Phone:715-834-0975
Mailing Address - Fax:715-855-9174
Practice Address - Street 1:215 E BROWN ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WI
Practice Address - Zip Code:54722-9346
Practice Address - Country:US
Practice Address - Phone:715-834-0975
Practice Address - Fax:715-855-9174
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI787-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42737600Medicaid