Healthcare Provider Details

I. General information

NPI: 1700574449
Provider Name (Legal Business Name): KATHERINE MARY LAMICH SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 04/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E RAWSON AVE STE 317
OAK CREEK WI
53154-1525
US

IV. Provider business mailing address

140 E RAWSON AVE STE 317
OAK CREEK WI
53154-1525
US

V. Phone/Fax

Practice location:
  • Phone: 262-287-0090
  • Fax: 262-923-1939
Mailing address:
  • Phone: 262-287-0090
  • Fax: 262-923-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5463-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: