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NPI Code Detail

MEDICARE: REBECCA S BOLDA SLP

MEDICARE: REBECCA S BOLDA SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist628-154WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073788154
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA S BOLDA SLP
Provider Business Mailing Address
First Line : 6735 W BRADLEY RD
Second Line :
City : MILWAUKEE
State : WI
Zip : 53223-3325
Country : US
Telephone Number : 414-354-3300
Fax Number :
Provider Business Practice Location Address
First Line : 6735 W BRADLEY RD
Second Line :
City : MILWAUKEE
State : WI
Zip : 53223-3325
Country : US
Telephone Number : 414-354-3300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2008
Last Update Date : 04/29/2008

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Directions to “ REBECCA S BOLDA SLP” Practice Location

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