Provider Demographics
NPI:1225248651
Name:EKLUND, ADELE CASTILLO
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:CASTILLO
Last Name:EKLUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 W FAIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4048
Mailing Address - Country:US
Mailing Address - Phone:414-228-7675
Mailing Address - Fax:
Practice Address - Street 1:5600 W BROWN DEER RD
Practice Address - Street 2:STE. 4
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223
Practice Address - Country:US
Practice Address - Phone:414-355-3060
Practice Address - Fax:414-355-3547
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42627300Medicaid