Provider Demographics
NPI:1508358672
Name:LEA, AUDRA
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:LEA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7818 BIG SKY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2840
Mailing Address - Country:US
Mailing Address - Phone:608-820-1180
Mailing Address - Fax:
Practice Address - Street 1:7818 BIG SKY DR STE 101
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2840
Practice Address - Country:US
Practice Address - Phone:608-820-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4665154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist