Provider Demographics
NPI:1639221328
Name:BURG, LINDA SUE (AUD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUE
Last Name:BURG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 TWO RIVERS CT
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9546
Mailing Address - Country:US
Mailing Address - Phone:414-805-5586
Mailing Address - Fax:414-805-7936
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPT OF OTOLARYNGOLOGY AND COMMUNICATION SCIENCES
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5586
Practice Address - Fax:414-805-7936
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1639221328Medicaid
WI41113700Medicaid