Healthcare Provider Details

I. General information

NPI: 1063317378
Provider Name (Legal Business Name): DIANE MARIE FELDKAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 W GREEN AVE
MILWAUKEE WI
53221-4178
US

IV. Provider business mailing address

4520 N WILSON DR APT 3
SHOREWOOD WI
53211-1343
US

V. Phone/Fax

Practice location:
  • Phone: 414-304-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: