Provider Demographics
NPI:1154846038
Name:WARNER, LINDA MICHELLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MICHELLE
Last Name:WARNER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MICHELLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:742 STERBENZ DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8327
Mailing Address - Country:US
Mailing Address - Phone:715-386-2128
Mailing Address - Fax:
Practice Address - Street 1:742 STERBENZ DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016
Practice Address - Country:US
Practice Address - Phone:715-386-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist