Healthcare Provider Details

I. General information

NPI: 1821079286
Provider Name (Legal Business Name): POUL-ERIK TRANSO CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E BLUFF ST
BOSCOBEL WI
53805-1610
US

IV. Provider business mailing address

109 E BLUFF ST
BOSCOBEL WI
53805-1610
US

V. Phone/Fax

Practice location:
  • Phone: 608-375-4327
  • Fax: 608-375-2351
Mailing address:
  • Phone: 608-375-4327
  • Fax: 608-375-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number176-156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: