MEDICARE: MRS. KATHLEEN MARIE VIELGUT MS/CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	737-154	WI

General Provider Information

NPI Number	:	1073824967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN MARIE VIELGUT MS/CCC-SLP

Provider Business Mailing Address
First Line	:	101 JEFFERY CT
Second Line	:
City	:	NORTH PRAIRIE
State	:	WI
Zip	:	53153-9770
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	837 E VETERANS WAY
Second Line	:
City	:	MUKWONAGO
State	:	WI
Zip	:	53149-1013
Country	:	US
Telephone Number	:	262-363-6830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	01/20/2023

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