Provider Demographics
NPI:1578210175
Name:MADSEN, LEE-ANNE MARIE
Entity type:Individual
Prefix:
First Name:LEE-ANNE
Middle Name:MARIE
Last Name:MADSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 N COMMERCE ST APT 213
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3489
Mailing Address - Country:US
Mailing Address - Phone:630-995-0500
Mailing Address - Fax:
Practice Address - Street 1:1810 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5616
Practice Address - Country:US
Practice Address - Phone:262-548-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5381-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist