MEDICARE: MS. SADIE LYNN MLEZIVA 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	2506154	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629270012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SADIE LYNN MLEZIVA MS CCC SLP

Provider Business Mailing Address
First Line	:	E700 JJ RD
Second Line	:
City	:	LUXEMBURG
State	:	WI
Zip	:	54217-7546
Country	:	US
Telephone Number	:	920-422-2051
Fax Number	:

Provider Business Practice Location Address
First Line	:	318 N MAIN ST
Second Line	:
City	:	LUXEMBURG
State	:	WI
Zip	:	54217-1129
Country	:	US
Telephone Number	:	920-845-2371
Fax Number	:

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	03/05/2026

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