Kennelly, Stacy Ann

Kennelly, Stacy Ann is an individual health care provider with primary practice located at 1612 N 37Th Street , Superior WI 54880. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Kennelly, Stacy Ann can be contacted via phone (715) 392-5144.

Contact Information

Primary practice address
1612 N 37Th Street Superior WI 54880
Phone: (715) 392-5144
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 6496024 Wisconsin
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 5371 Minnesota

Profile Details

NPI number 1528261989
LBN Legal business name Kennelly, Stacy Ann
Credentials MA PT
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 6th, 2007
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528261989 NPPES
Wisconsin MEDICAID 40382400

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