Provider Demographics
NPI:1467089672
Name:SANTUCCI, JOHN PAUL (HIS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:SANTUCCI
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7945 W LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3710
Mailing Address - Country:US
Mailing Address - Phone:414-421-4556
Mailing Address - Fax:
Practice Address - Street 1:7945 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-3710
Practice Address - Country:US
Practice Address - Phone:414-421-5320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1593-60237700000X
WI1593237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist