Healthcare Provider Details

I. General information

NPI: 1164352696
Provider Name (Legal Business Name): BRENDA MONTANYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 LAKE ST
PEWAUKEE WI
53072-3630
US

IV. Provider business mailing address

W324S8580 NEBO TRL
MUKWONAGO WI
53149-9285
US

V. Phone/Fax

Practice location:
  • Phone: 262-691-2100
  • Fax:
Mailing address:
  • Phone: 608-921-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: