Provider Demographics
NPI:1932627692
Name:NUERNBERG, ANDREA LOUISE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LOUISE
Last Name:NUERNBERG
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LOUISE
Other - Last Name:WENZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:17700 W CAPITOL DR
Mailing Address - Street 2:LESSILA THERAPY
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2006
Mailing Address - Country:US
Mailing Address - Phone:262-781-3083
Mailing Address - Fax:262-781-3080
Practice Address - Street 1:198 COUNTY ROAD DF
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039-9515
Practice Address - Country:US
Practice Address - Phone:920-386-3548
Practice Address - Fax:920-239-3997
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14052695235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI14052695OtherLICENSE NUMBER