Provider Demographics
NPI:1720716319
Name:ISDAHL, MARIAN M
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:M
Last Name:ISDAHL
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 1:5201 OLD MIDDLETON RD APT 312
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2724
Mailing Address - Country:US
Mailing Address - Phone:919-279-3768
Mailing Address - Fax:
Practice Address - Street 1:5201 OLD MIDDLETON RD APT 312
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2724
Practice Address - Country:US
Practice Address - Phone:919-279-3768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6006235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist