Provider Demographics
NPI:1922028695
Name:ZWILLING, STACI RAE (MS, SLP)
Entity Type:Individual
Prefix:MS
First Name:STACI
Middle Name:RAE
Last Name:ZWILLING
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:R
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W7989 COUNTY ROAD A
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-2627
Mailing Address - Country:US
Mailing Address - Phone:262-903-0124
Mailing Address - Fax:
Practice Address - Street 1:2025 E NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2906
Practice Address - Country:US
Practice Address - Phone:414-961-4160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2738-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist