1023204260 NPI number — SUSAN M STONE MSCCCSLP

Table of content: SUSAN M STONE MSCCCSLP (NPI 1023204260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023204260 NPI number — SUSAN M STONE MSCCCSLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STONE
Provider First Name:
SUSAN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSCCCSLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023204260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 55
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUKAU
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54980-0055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-904-7000
Provider Business Mailing Address Fax Number:
920-685-0350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2626 MECHANIC STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUKAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54980-0055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-904-7000
Provider Business Practice Location Address Fax Number:
920-685-0350
Provider Enumeration Date:
09/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  60349030 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 1717-154 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1717-154 . This is a "STATE OF WISCONSIN LISCEN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 42766400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35031100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60349030 . This is a "RN, STATE LICENSE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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