MEDICARE: MS. KRISTIN LEIGH SCHUPPERT MA CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2211-154	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578616876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIN LEIGH SCHUPPERT MA CCC-SLP

Provider Business Mailing Address
First Line	:	THE PARENTING PLACE
Second Line	:	1500 GREEN BAY STREET
City	:	LA CROSSE
State	:	WI
Zip	:	54601-6455
Country	:	US
Telephone Number	:	608-784-8125
Fax Number	:	608-796-0098

Provider Business Practice Location Address
First Line	:	THE PARENTING PLACE
Second Line	:	1500 GREEN BAY STREET
City	:	LA CROSSE
State	:	WI
Zip	:	54601-6455
Country	:	US
Telephone Number	:	608-784-8125
Fax Number	:	608-796-0098

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	03/21/2019

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