Provider Demographics
NPI:1467493205
Name:WHIPPLE, SUSAN R (MA, F-AAA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:MA, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-1281
Mailing Address - Country:US
Mailing Address - Phone:920-887-2822
Mailing Address - Fax:
Practice Address - Street 1:6220 WASHINGTON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3952
Practice Address - Country:US
Practice Address - Phone:262-884-0600
Practice Address - Fax:262-884-0543
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI529-156237600000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1467493205Medicaid
MI904580123Medicaid
WI1467493205Medicaid
MI904580123Medicaid