Healthcare Provider Details

I. General information

NPI: 1346629078
Provider Name (Legal Business Name): MAYA TUINSTRA M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N9443 EMILY LN
APPLETON WI
54915-8509
US

IV. Provider business mailing address

N9443 EMILY LN
APPLETON WI
54915-8509
US

V. Phone/Fax

Practice location:
  • Phone: 920-470-5644
  • Fax:
Mailing address:
  • Phone: 920-470-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4109-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: