Basic Information
| Provider Information | |||||||||
| NPI: | 1780316570 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STICH | ||||||||
| FirstName: | TRISHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21600 STATE HIGHWAY 78 | ||||||||
| Address2: | |||||||||
| City: | BATTLE LAKE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565159285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122455496 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2600 COMPASS RD | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600268001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474415593 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2022 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 10065 | MN | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.