Healthcare Provider Details

I. General information

NPI: 1124950449
Provider Name (Legal Business Name): MELISSA JOHANNA KAISER MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 S MAIN ST
WEST BEND WI
53095-3965
US

IV. Provider business mailing address

888 DUBLIN DR
HARTFORD WI
53027-9765
US

V. Phone/Fax

Practice location:
  • Phone: 262-335-5430
  • Fax:
Mailing address:
  • Phone: 262-623-1821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1590044915
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: