=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528447778
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILWAUKEE BILINGUAL SPEECH/LANGUAGE PATHOLOGISTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2015
-----------------------------------------------------
Last Update Date | 05/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2532 N NEWHALL ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53211-3964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-326-8689
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 342507
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53234-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-326-8689
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/PARTNER/OWNER
-----------------------------------------------------
Name | HOLLY M DELGADO
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 414-326-8689
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 2798-154
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number | 2798-154
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------