Individual
KELLY MARIE LIEBERGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9000 W SURA LN, GREENFIELD, WI 53228-3477
(414) 246-6800
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
L162-5009-3930-07
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100094667
—
WI
Enumeration date
09/19/2019
Last updated
11/05/2025
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