Healthcare Provider Details

I. General information

NPI: 1962177287
Provider Name (Legal Business Name): ALISHA URBAN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N 92ND ST
MILWAUKEE WI
53226-3533
US

IV. Provider business mailing address

1538 N CASS ST
MILWAUKEE WI
53202-2024
US

V. Phone/Fax

Practice location:
  • Phone: 262-782-9015
  • Fax:
Mailing address:
  • Phone: 630-589-4874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4941-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: