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General NPI Number Information
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NPI Number | 1386504686
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Entity Type | Organization
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Legal Business Name | UNIVERSITY LAKE SCHOOL INC
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Dates
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Enumeration Date | 11/18/2025
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 4024 NAGAWICKA RD
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City | HARTLAND
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State | WI
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Zip | 53029-9363
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Country | US
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Telephone | 262-501-3255
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Fax | 262-214-0157
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Provider Business Mailing Address
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Address Line | 4024 NAGAWICKA RD
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City | HARTLAND
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State | WI
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Zip | 53029-9363
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Country | US
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Telephone | 262-501-3255
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Fax | 262-214-0157
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Authorized Official
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Title or Position | CFO
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Name | MELISSA BENSON
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Credential |
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Telephone | 262-367-6011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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