Healthcare Provider Details

I. General information

NPI: 1417392960
Provider Name (Legal Business Name): EAR NOSE AND THROAT SPECIALISTS OF WISCONSIN, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E BELL ST
NEENAH WI
54956
US

IV. Provider business mailing address

119 E BELL ST
NEENAH WI
54956-4993
US

V. Phone/Fax

Practice location:
  • Phone: 920-969-1768
  • Fax: 920-486-6710
Mailing address:
  • Phone: 920-969-1768
  • Fax: 920-486-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1422-60
License Number StateWI

VIII. Authorized Official

Name: MRS. JODIE FROHNE
Title or Position: OFFICE MANAGER
Credential:
Phone: 920-303-4143