Provider Demographics
NPI:1629790217
Name:KREIS, MADELINE (SLP)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:KREIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 COMMERCE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3700
Mailing Address - Country:US
Mailing Address - Phone:262-497-7270
Mailing Address - Fax:877-530-0135
Practice Address - Street 1:1100 COMMERCE DR STE 103
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3700
Practice Address - Country:US
Practice Address - Phone:262-497-7270
Practice Address - Fax:877-530-0135
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6069-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist