Provider Demographics
NPI:1043443211
Name:WILLEMON, JUSTEN JOHN (BC-HIS)
Entity Type:Individual
Prefix:
First Name:JUSTEN
Middle Name:JOHN
Last Name:WILLEMON
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 SCHOFIELD AVE STE G
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2411
Mailing Address - Country:US
Mailing Address - Phone:715-298-2828
Mailing Address - Fax:
Practice Address - Street 1:3109 RIB MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-0650
Practice Address - Country:US
Practice Address - Phone:715-842-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist