Healthcare Provider Details

I. General information

NPI: 1699014571
Provider Name (Legal Business Name): MONROE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 YAHARA RD
STOUGHTON WI
53589-3369
US

IV. Provider business mailing address

2714 YAHARA RD
STOUGHTON WI
53589-3369
US

V. Phone/Fax

Practice location:
  • Phone: 608-609-0521
  • Fax:
Mailing address:
  • Phone: 608-609-0521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number4874-27
License Number StateWI

VIII. Authorized Official

Name: MS. SUSAN W CARON
Title or Position: CERTIFIED OCCUPATIONAL THERAPY ASSI
Credential: L/COTA
Phone: 608-609-0521