Healthcare Provider Details

I. General information

NPI: 1972408060
Provider Name (Legal Business Name): STEPHANIE COBBS WOLOSHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MILWAUKEE STREET, CLINTON, WI 53525.
CLINTON WI
53525
US

IV. Provider business mailing address

112 MILWAUKEE STREET, CLINTON, WI 53525.
CLINTON WI
53525
US

V. Phone/Fax

Practice location:
  • Phone: 608-676-2211
  • Fax:
Mailing address:
  • Phone: 608-676-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1590012613
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: