=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942007331
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRISHA ANN BALLSCHMIEDER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2025
-----------------------------------------------------
Last Update Date | 02/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 W ELM DR
-----------------------------------------------------
City | LITTLE CHUTE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54140-2661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-219-5438
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 E ELM DR
-----------------------------------------------------
City | LITTLE CHUTE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54140-1292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-219-5438
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 0019788
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------