Provider Demographics
NPI:1265676183
Name:TOMASIK, DELORES E
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:E
Last Name:TOMASIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3552 E LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1409
Mailing Address - Country:US
Mailing Address - Phone:414-744-0449
Mailing Address - Fax:414-744-1315
Practice Address - Street 1:3552 E LAYTON AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-1409
Practice Address - Country:US
Practice Address - Phone:414-744-0449
Practice Address - Fax:414-744-1315
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1221060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42838500Medicaid