Provider Demographics
NPI:1831362490
Name:ENTLER, PATRICIA A (MS, DRL LICENSE)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:A
Last Name:ENTLER
Suffix:
Gender:F
Credentials:MS, DRL LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 W POWELL RD
Mailing Address - Street 2:
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552-6215
Mailing Address - Country:US
Mailing Address - Phone:715-476-9181
Mailing Address - Fax:
Practice Address - Street 1:628 W POWELL RD
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552-6215
Practice Address - Country:US
Practice Address - Phone:715-476-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1273 DRL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42589200Medicaid