Provider Demographics
NPI:1548771785
Name:SUEFLOHN, ANTOINETTE B (SLP)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:B
Last Name:SUEFLOHN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:B
Other - Last Name:CRIBBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:RANDOM LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53075-0323
Mailing Address - Country:US
Mailing Address - Phone:920-994-9700
Mailing Address - Fax:
Practice Address - Street 1:402 1ST ST
Practice Address - Street 2:
Practice Address - City:RANDOM LAKE
Practice Address - State:WI
Practice Address - Zip Code:53075-1772
Practice Address - Country:US
Practice Address - Phone:920-994-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1846-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist