Healthcare Provider Details

I. General information

NPI: 1548866056
Provider Name (Legal Business Name): BREANNA STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W6127 LORNA LN
APPLETON WI
54915-7465
US

IV. Provider business mailing address

371 FOSTER ST
OSHKOSH WI
54902-5717
US

V. Phone/Fax

Practice location:
  • Phone: 920-840-3033
  • Fax:
Mailing address:
  • Phone: 715-219-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5152-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: