Individual
STACEY DELFORGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
337 MAIN ST, BIRNAMWOOD, WI 54414-9259
(715) 449-2576
Mailing address
P1561 OLD LAKE RD, BIRNAMWOOD, WI 54414-9418
(715) 449-3362
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1708154
WI
Other
Enumeration date
03/12/2012
Last updated
03/12/2012
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