Healthcare Provider Details

I. General information

NPI: 1649896846
Provider Name (Legal Business Name): ALLYSON STONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 W WATERTOWN PLANK RD
WAUWATOSA WI
53226-3595
US

IV. Provider business mailing address

N91W16112 JUNCTION WAY APT 308
MENOMONEE FALLS WI
53051-3195
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-7111
  • Fax:
Mailing address:
  • Phone: 608-516-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1869
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: