Provider Demographics
NPI:1003952805
Name:UNIVERSITY OF WI - SPEECH, LANGUAGE, AND HEARING CLINIC
Entity Type:Organization
Organization Name:UNIVERSITY OF WI - SPEECH, LANGUAGE, AND HEARING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-346-3667
Mailing Address - Street 1:1901 4TH AVE
Mailing Address - Street 2:COLLEGE OF PROFESSIONAL STUDIES, UW-STEVENS POINT
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1909
Mailing Address - Country:US
Mailing Address - Phone:715-346-3667
Mailing Address - Fax:715-346-2157
Practice Address - Street 1:1901 4TH AVE
Practice Address - Street 2:COLLEGE OF PROFESSIONAL STUDIES, UW-STEVENS POINT
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1909
Practice Address - Country:US
Practice Address - Phone:715-346-3667
Practice Address - Fax:715-346-2157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF WI - SPEECH, LANGUAGE, AND HEARING CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41172500Medicaid