Provider Demographics
NPI:1902943210
Name:SEMLING, SHARON-DIANE WESSLUND (PT)
Entity Type:Individual
Prefix:
First Name:SHARON-DIANE
Middle Name:WESSLUND
Last Name:SEMLING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-8107
Mailing Address - Country:US
Mailing Address - Phone:715-675-9925
Mailing Address - Fax:
Practice Address - Street 1:520 N 32ND AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4701
Practice Address - Country:US
Practice Address - Phone:715-847-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4111-024251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40343000Medicaid