Healthcare Provider Details

I. General information

NPI: 1003952805
Provider Name (Legal Business Name): UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 4TH AVE COLLEGE OF PROFESSIONAL STUDIES, UW-STEVENS POINT
STEVENS POINT WI
54481-1909
US

IV. Provider business mailing address

1901 4TH AVE COLLEGE OF PROFESSIONAL STUDIES, UW-STEVENS POINT
STEVENS POINT WI
54481-1909
US

V. Phone/Fax

Practice location:
  • Phone: 715-346-3667
  • Fax: 715-346-2157
Mailing address:
  • Phone: 715-346-3667
  • Fax: 715-346-2157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KAY JUHNKE
Title or Position: OFFICE MANAGER
Credential:
Phone: 715-346-3667