Provider Demographics
NPI:1184197659
Name:STENULSON, KELLY SUE (BACHLORS DEGREE)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SUE
Last Name:STENULSON
Suffix:
Gender:F
Credentials:BACHLORS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 E IVES ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1558
Mailing Address - Country:US
Mailing Address - Phone:715-223-5819
Mailing Address - Fax:
Practice Address - Street 1:503 E IVES ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-1558
Practice Address - Country:US
Practice Address - Phone:715-223-5819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator