Provider Demographics
NPI:1861725418
Name:DIMOND, STACEY D (AUD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:D
Last Name:DIMOND
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 OAKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-1744
Mailing Address - Country:US
Mailing Address - Phone:651-285-2205
Mailing Address - Fax:
Practice Address - Street 1:1440 ONEIDA ST
Practice Address - Street 2:N
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-7101
Practice Address - Country:US
Practice Address - Phone:920-731-9579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8548231H00000X
WI578-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist