Healthcare Provider Details

I. General information

NPI: 1356251193
Provider Name (Legal Business Name): SUZANNE WEATHERSBY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 N 80TH ST
MILWAUKEE WI
53223-5506
US

IV. Provider business mailing address

2233 N SUMMIT AVE APT 602
MILWAUKEE WI
53202-1288
US

V. Phone/Fax

Practice location:
  • Phone: 414-393-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6974-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: