Provider Demographics
NPI:1114000163
Name:MILLHOLLAND, KAREN JANET (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JANET
Last Name:MILLHOLLAND
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 S ARTHUR CIR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1600
Mailing Address - Country:US
Mailing Address - Phone:608-698-4226
Mailing Address - Fax:
Practice Address - Street 1:14 ELLIS POTTER CT STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2478
Practice Address - Country:US
Practice Address - Phone:608-204-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI143-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42686600Medicaid