Van Grinsven, Stacey Lyn
Van Grinsven, Stacey Lyn is an sole proprietor health care provider with primary practice located at 1601 Lawrence Dr Ste 100 , De Pere WI 54115-3931. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Van Grinsven, Stacey Lyn can be contacted via phone (920) 496-4700.Contact Information
Primary practice address
1601 Lawrence Dr Ste 100
De Pere WI 54115-3931
Phone: (920) 496-4700
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | 2953-154 | Wisconsin |
Profile Details
| NPI number | 1104018514 |
|---|---|
| LBN Legal business name | Van Grinsven, Stacey Lyn |
| Credentials | MS, CFY-SLP |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 10th, 2007 |
| Last updated | Jan 18th, 2024 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104018514 | NPPES |
| Wisconsin | MEDICAID | 42592900 |
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