Provider Demographics
NPI:1326408279
Name:WASSHAUSEN, SEAN RUSSELL (MA, LAT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:RUSSELL
Last Name:WASSHAUSEN
Suffix:
Gender:M
Credentials:MA, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 ROUNDS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-2041
Mailing Address - Country:US
Mailing Address - Phone:715-716-6914
Mailing Address - Fax:
Practice Address - Street 1:445 W SWIFT CREEK LN
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-8004
Practice Address - Country:US
Practice Address - Phone:307-248-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer