Provider Demographics
NPI:1811163447
Name:HADLER, JO ANNE
Entity type:Individual
Prefix:MS
First Name:JO
Middle Name:ANNE
Last Name:HADLER
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 1:437 WOODHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-9116
Mailing Address - Country:US
Mailing Address - Phone:262-365-3457
Mailing Address - Fax:
Practice Address - Street 1:437 WOODHAVEN DR
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-9116
Practice Address - Country:US
Practice Address - Phone:262-365-3457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI773-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42681200Medicaid