Provider Demographics
NPI:1780731711
Name:STASIUK, WOLODYMYR R (ACA, BC-HIS)
Entity type:Individual
Prefix:MR
First Name:WOLODYMYR
Middle Name:R
Last Name:STASIUK
Suffix:
Gender:M
Credentials:ACA, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 GLANCY ST
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2306
Mailing Address - Country:US
Mailing Address - Phone:615-851-3901
Mailing Address - Fax:615-851-3903
Practice Address - Street 1:124 GLANCY ST
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2306
Practice Address - Country:US
Practice Address - Phone:615-851-3901
Practice Address - Fax:615-851-3903
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN410237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN42-1566005OtherFEDERAL TAX I.D. NUMBER