Provider Demographics
NPI:1215771480
Name:STRANDBERG, MADELINE ROSE KLINK (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:ROSE KLINK
Last Name:STRANDBERG
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:ROSE
Other - Last Name:KLINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1103 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-5236
Mailing Address - Country:US
Mailing Address - Phone:262-490-8690
Mailing Address - Fax:
Practice Address - Street 1:1103 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-5236
Practice Address - Country:US
Practice Address - Phone:262-490-8690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6587-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist