Provider Demographics
NPI:1679793616
Name:GOLEC, ALISHA ELIZABETH (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:ELIZABETH
Last Name:GOLEC
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:ELIZABETH
Other - Last Name:DEBYL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CF-SLP
Mailing Address - Street 1:9418 N GREEN BAY RD APT 112
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53209-1000
Mailing Address - Country:US
Mailing Address - Phone:414-477-6793
Mailing Address - Fax:
Practice Address - Street 1:N27W5707 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2852
Practice Address - Country:US
Practice Address - Phone:262-376-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2846-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2846-154OtherSTATE LISCENSE NUMBER
WI42580600Medicaid