Provider Demographics
NPI:1992180855
Name:STIPANCIC, KAILA LAUREN
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:LAUREN
Last Name:STIPANCIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N BLAIR ST
Mailing Address - Street 2:APT #5
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2463
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 N BLAIR ST
Practice Address - Street 2:APT #5
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2463
Practice Address - Country:US
Practice Address - Phone:608-263-6190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4160-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist