Provider Demographics
NPI:1356993687
Name:DE STADLER, MARIE J (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:J
Last Name:DE STADLER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:J
Other - Last Name:ROZEBOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2868 OSMUNDSEN RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5161
Mailing Address - Country:US
Mailing Address - Phone:978-973-4147
Mailing Address - Fax:
Practice Address - Street 1:2868 OSMUNDSEN RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5161
Practice Address - Country:US
Practice Address - Phone:978-973-4147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4851235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist