Provider Demographics
NPI:1073287165
Name:OSBORNE, AIDAN L (SLP)
Entity type:Individual
Prefix:
First Name:AIDAN
Middle Name:L
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 PROSPECT COMMONS
Mailing Address - Street 2:APT 214
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 PROSPECT COMMONS
Practice Address - Street 2:APT 214
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590
Practice Address - Country:US
Practice Address - Phone:779-437-4922
Practice Address - Fax:608-263-6199
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5299-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist