MEDICARE: MRS. EMILY H. STAFSLIEN SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	1001441614	WI
2	235Z00000X	Speech-Language Pathologist	SLP-SP-LIC-4023	MT
3	235Z00000X	Speech-Language Pathologist	3671-154	WI

General Provider Information

NPI Number	:	1871849695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY H. STAFSLIEN SLP

Provider Business Mailing Address
First Line	:	N5936 STATE ROAD 22
Second Line	:
City	:	WILD ROSE
State	:	WI
Zip	:	54984-9137
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	E2325 KING RD
Second Line	:
City	:	WAUPACA
State	:	WI
Zip	:	54981-8270
Country	:	US
Telephone Number	:	715-258-4121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	06/02/2026

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