Provider Demographics
NPI:1235356973
Name:RAMTHUN, STACIE SE (MS, CCC)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:SE
Last Name:RAMTHUN
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 KINNICKINNIC ST.
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MN
Mailing Address - Zip Code:55401
Mailing Address - Country:US
Mailing Address - Phone:715-381-3536
Mailing Address - Fax:
Practice Address - Street 1:561 7TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3009
Practice Address - Country:US
Practice Address - Phone:651-225-4558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN66283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist