Provider Demographics
NPI:1710499736
Name:LEHNERT, MADDIE (SLP)
Entity Type:Individual
Prefix:
First Name:MADDIE
Middle Name:
Last Name:LEHNERT
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:PO BOX 139
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:WI
Mailing Address - Zip Code:54412-0139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10564 SCHOOL AVENUE
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:WI
Practice Address - Zip Code:54412
Practice Address - Country:US
Practice Address - Phone:715-652-2812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4457235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist