Basic Information
| Provider Information | |||||||||
| NPI: | 1003924846 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARSCEAU | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | ST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 WESTHILL DR | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544013795 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3402 HOWLAND AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WESTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544765633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153555701 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 126-154 | WI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 42788800 | 05 | WI | MEDICAID |