Provider Demographics
NPI:1851661748
Name:BOSTWICK, DANELLE ANN (SLP)
Entity Type:Individual
Prefix:
First Name:DANELLE
Middle Name:ANN
Last Name:BOSTWICK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:DANELLE
Other - Middle Name:ANN
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:2080 WINDSOR CT APT 8
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-4153
Mailing Address - Country:US
Mailing Address - Phone:715-498-7870
Mailing Address - Fax:
Practice Address - Street 1:111 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54495-2702
Practice Address - Country:US
Practice Address - Phone:715-421-8848
Practice Address - Fax:715-421-8693
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2539154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist