Provider Demographics
NPI:1548737455
Name:MILWAUKEE SWALLOWING AND VOICE SPECIALISTS
Entity Type:Organization
Organization Name:MILWAUKEE SWALLOWING AND VOICE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE
Authorized Official - Prefix:MR
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:414-526-0964
Mailing Address - Street 1:8771 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9775
Mailing Address - Country:US
Mailing Address - Phone:414-698-5813
Mailing Address - Fax:
Practice Address - Street 1:5220 N DIVERSEY BLVD
Practice Address - Street 2:
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53217-5161
Practice Address - Country:US
Practice Address - Phone:414-526-0964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1144739418Medicaid