Healthcare Provider Details

I. General information

NPI: 1326261504
Provider Name (Legal Business Name): BETHANY C FROSTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 HUNTERS TRL
PORTAGE WI
53901-3429
US

IV. Provider business mailing address

707 14TH ST
BARABOO WI
53913-1539
US

V. Phone/Fax

Practice location:
  • Phone: 608-742-7161
  • Fax: 608-745-3990
Mailing address:
  • Phone: 608-356-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number354-156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: