Provider Demographics
NPI:1639210255
Name:PASBRIG, MARY GOES (MS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:GOES
Last Name:PASBRIG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:MARTHA
Other - Last Name:GOES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:11210 W GILBERT AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2258
Mailing Address - Country:US
Mailing Address - Phone:414-258-9547
Mailing Address - Fax:
Practice Address - Street 1:17160 W NORTH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4437
Practice Address - Country:US
Practice Address - Phone:262-789-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI440-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist