Provider Demographics
NPI:1215424726
Name:GREIS, MONICA JEAN
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:JEAN
Last Name:GREIS
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:N857 ERIN RD
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-9609
Mailing Address - Country:US
Mailing Address - Phone:414-745-1436
Mailing Address - Fax:
Practice Address - Street 1:N857 ERIN RD
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-9609
Practice Address - Country:US
Practice Address - Phone:414-745-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4620-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist