Provider Demographics
NPI:1043609118
Name:VIERLING, SEAN THOMAS
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:THOMAS
Last Name:VIERLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MAIN STREET
Mailing Address - Street 2:STE 1
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650
Mailing Address - Country:US
Mailing Address - Phone:608-781-6881
Mailing Address - Fax:608-781-1762
Practice Address - Street 1:1101 MAIN STREET
Practice Address - Street 2:STE 1
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650
Practice Address - Country:US
Practice Address - Phone:608-781-6881
Practice Address - Fax:608-781-1762
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1377-060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100085673Medicaid