Provider Demographics
NPI:1356763700
Name:LEUPOLD, NATHAN W (MS/CFY-SLP)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:W
Last Name:LEUPOLD
Suffix:
Gender:M
Credentials:MS/CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7517 W COLDSPRING RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-2814
Mailing Address - Country:US
Mailing Address - Phone:414-327-6603
Mailing Address - Fax:414-327-5511
Practice Address - Street 1:3216 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3252
Practice Address - Country:US
Practice Address - Phone:414-344-6515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-19
Last Update Date:2014-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3842-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist