Healthcare Provider Details

I. General information

NPI: 1093268187
Provider Name (Legal Business Name): KATTHLEEN LLAURADO MS,CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 N 26TH ST
MILWAUKEE WI
53233-1507
US

IV. Provider business mailing address

833 N 26TH ST
MILWAUKEE WI
53233-1507
US

V. Phone/Fax

Practice location:
  • Phone: 414-344-7676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number100043931
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: