Organization
MILWAUKEE SWALLOWING AND VOICE SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GAVIN LONG M.S. CCC-SLP (SPEECH LANGUAGE)
(414) 526-0964
Entity
Organization
Contact information
Practice address
5220 N DIVERSEY BLVD, WHITEFISH BAY, WI 53217-5161
(414) 526-0964
Mailing address
8771 S 84TH ST, FRANKLIN, WI 53132-9775
(414) 698-5813
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144739418
—
WI
Enumeration date
10/29/2018
Last updated
11/10/2018
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