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General NPI Number Information
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NPI Number | 1235088816
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Entity Type | Individual
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Provider Name | STACIE GRISWOLD
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Gender | Female
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Dates
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Enumeration Date | 01/26/2026
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 1314 S 1ST ST # 276
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City | MILWAUKEE
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State | WI
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Zip | 53204-2405
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Country | US
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Telephone | 407-375-3003
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Fax |
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Provider Business Mailing Address
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Address Line | W319N825 COBBLESTONE CT
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City | DELAFIELD
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State | WI
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Zip | 53018-2643
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 6717-16
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License Number State | WI
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