Provider Demographics
NPI:1457593394
Name:MINEAU, SUZETTE M (MA)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:M
Last Name:MINEAU
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SUZETTE
Other - Middle Name:M
Other - Last Name:STEINBACH-MINEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:5000 CHESHIRE PKWY N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4103
Mailing Address - Country:US
Mailing Address - Phone:888-510-0766
Mailing Address - Fax:
Practice Address - Street 1:W186N9523 BANCROFT DR
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-8009
Practice Address - Country:US
Practice Address - Phone:262-502-3570
Practice Address - Fax:262-502-3572
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI244231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00725805OtherRR MEDICARE
WI01994-0402Medicare PIN
WI46236-4638Medicare PIN