Provider Demographics
NPI:1902456627
Name:PARTLO, RAYMOND ALLEN (BS)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ALLEN
Last Name:PARTLO
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 RADTKE ST
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-1149
Mailing Address - Country:US
Mailing Address - Phone:715-351-9849
Mailing Address - Fax:
Practice Address - Street 1:115 N 6TH ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-5519
Practice Address - Country:US
Practice Address - Phone:715-849-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-14
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator