Provider Demographics
NPI:1922338953
Name:RUNDE, SAMUEL J (WISCONSIN LICENSED H)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:RUNDE
Suffix:
Gender:M
Credentials:WISCONSIN LICENSED H
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 SANDY HOOK RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53811-9319
Mailing Address - Country:US
Mailing Address - Phone:563-513-8623
Mailing Address - Fax:
Practice Address - Street 1:2055 HOLLIDAY DR STE 340
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-0415
Practice Address - Country:US
Practice Address - Phone:563-513-8623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI709-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist