Provider Demographics
NPI:1053454181
Name:ZAFFKE, LINDA A (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:ZAFFKE
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 ELIZA ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3234
Mailing Address - Country:US
Mailing Address - Phone:920-965-4800
Mailing Address - Fax:920-431-7024
Practice Address - Street 1:923 ELIZA ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3234
Practice Address - Country:US
Practice Address - Phone:920-965-4800
Practice Address - Fax:920-431-7024
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI57-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41101100Medicaid
WI071050001OtherMEDICARE PTAN