Provider Demographics
NPI:1063689453
Name:VANDE ZANDE, LINDA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:VANDE ZANDE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8250 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-9517
Mailing Address - Country:US
Mailing Address - Phone:920-921-7891
Mailing Address - Fax:
Practice Address - Street 1:244 N MACY ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3362
Practice Address - Country:US
Practice Address - Phone:920-926-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2186-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42574900Medicaid