Individual
MRS. SHIRLEY LOUISE CLEMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BC-HIS
Contact information
Practice address
1336 E WISCONSIN AVE, APPLETON, WI 54911-3969
(920) 733-7525
Mailing address
1336 E WISCONSIN AVE, APPLETON, WI 54911-3969
(920) 733-7525
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
424
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
424
WI STATE LICENSE
WI
05
—
42823200
—
WI
Enumeration date
07/18/2007
Last updated
07/18/2007
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