Healthcare Provider Details

I. General information

NPI: 1225316631
Provider Name (Legal Business Name): FAITH KING M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W134N6314 WINDRIFT PASS
MENOMONEE FALLS WI
53051-8334
US

IV. Provider business mailing address

W134N6314 WINDRIFT PASS
MENOMONEE FALLS WI
53051-8334
US

V. Phone/Fax

Practice location:
  • Phone: 262-825-5138
  • Fax:
Mailing address:
  • Phone: 262-825-5138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3563-154
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12128390
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: