Healthcare Provider Details

I. General information

NPI: 1396401667
Provider Name (Legal Business Name): STEPHANIE HOTUJEC ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 STEIN BLVD STE B
EAU CLAIRE WI
54701-2674
US

IV. Provider business mailing address

2620 STEIN BLVD STE B
EAU CLAIRE WI
54701-2674
US

V. Phone/Fax

Practice location:
  • Phone: 715-836-0064
  • Fax: 715-836-0065
Mailing address:
  • Phone: 715-836-0064
  • Fax: 715-836-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number694382
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: