Provider Demographics
NPI:1669729562
Name:LOCKEN, SEAN T
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:T
Last Name:LOCKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 SCHOFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2411
Mailing Address - Country:US
Mailing Address - Phone:715-392-2172
Mailing Address - Fax:
Practice Address - Street 1:2809 SCHOFIELD AVE
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-2411
Practice Address - Country:US
Practice Address - Phone:715-392-2172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1357-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist