Provider Demographics
NPI:1063649341
Name:BEIRNE, TROY (HIS)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:BEIRNE
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 S MAIN ST
Mailing Address - Street 2:STE C14
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-5766
Mailing Address - Country:US
Mailing Address - Phone:920-924-9380
Mailing Address - Fax:920-924-9384
Practice Address - Street 1:770 S MAIN ST
Practice Address - Street 2:STE C14
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-5766
Practice Address - Country:US
Practice Address - Phone:920-924-9380
Practice Address - Fax:920-924-9384
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1311-060235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist