Provider Demographics
NPI:1619397973
Name:STEFFEN, ANGELA (LAT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:STEFFEN
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12800 N LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-2418
Mailing Address - Country:US
Mailing Address - Phone:262-243-4537
Mailing Address - Fax:262-243-2969
Practice Address - Street 1:12800 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2418
Practice Address - Country:US
Practice Address - Phone:262-243-4537
Practice Address - Fax:262-243-2969
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI978-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer