Provider Demographics
NPI:1326447327
Name:COOK-FUGLSANG, SHEENA L (ATC)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:L
Last Name:COOK-FUGLSANG
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:SHEENA
Other - Middle Name:L
Other - Last Name:FUGLSANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:1725 STATE ST
Mailing Address - Street 2:10 MITCHELL HALL
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-3742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1725 STATE STREET
Practice Address - Street 2:MITCHELL HALL, ROOM 10
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-785-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI853-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer