Provider Demographics
NPI:1023204260
Name:STONE, SUSAN M (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:STONE
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:WAUKAU
Mailing Address - State:WI
Mailing Address - Zip Code:54980-0055
Mailing Address - Country:US
Mailing Address - Phone:920-904-7000
Mailing Address - Fax:920-685-0350
Practice Address - Street 1:2626 MECHANIC STREET
Practice Address - Street 2:
Practice Address - City:WAUKAU
Practice Address - State:WI
Practice Address - Zip Code:54980-0055
Practice Address - Country:US
Practice Address - Phone:920-904-7000
Practice Address - Fax:920-685-0350
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60349030163W00000X
WI1717-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1717-154OtherSTATE OF WISCONSIN LISCEN
WI42766400Medicaid
WI35031100Medicaid
WI60349030OtherRN, STATE LICENSE