Individual
MS. VICKY J EBENSPERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC MST SLP
Contact information
Practice address
808 MAIN ST E, MENOMONIE, WI 54751-2735
(715) 232-1116
(715) 232-5987
Mailing address
PO BOX 470, MENOMONIE, WI 54751-2735
(715) 232-1116
(715) 232-5987
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
1325-154
WI
235Z00000X
Speech-Language Pathologist
Primary
1325154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42750600
—
WI
05
—
43071900
—
WI
Enumeration date
05/23/2006
Last updated
10/16/2008
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