Provider Demographics
NPI:1205602984
Name:DILLMAN-STEIN, JADE M (CPM, LM)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:M
Last Name:DILLMAN-STEIN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-6815
Mailing Address - Country:US
Mailing Address - Phone:715-491-3224
Mailing Address - Fax:
Practice Address - Street 1:5420 20TH AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-6815
Practice Address - Country:US
Practice Address - Phone:715-491-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI264-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife