Provider Demographics
NPI:1528706454
Name:KLIMISCH, ACE LELAND (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ACE
Middle Name:LELAND
Last Name:KLIMISCH
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:KRISTIN
Other - Last Name:KLIMISCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7305 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4413
Mailing Address - Country:US
Mailing Address - Phone:262-344-7689
Mailing Address - Fax:
Practice Address - Street 1:230 WEST MONROE STREET
Practice Address - Street 2:SUITES 550 AND 625
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606
Practice Address - Country:US
Practice Address - Phone:312-577-7522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5485154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty