Provider Demographics
NPI:1043486426
Name:STINE, ROSEMARY (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:STINE
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 1:1525 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-7351
Mailing Address - Country:US
Mailing Address - Phone:920-469-1043
Mailing Address - Fax:
Practice Address - Street 1:1525 CREEKSIDE LN
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-7351
Practice Address - Country:US
Practice Address - Phone:920-469-1043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI593-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42727400Medicaid