Provider Demographics
NPI:1962885533
Name:GUNNINK, CARLA (HIS)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:GUNNINK
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 RICKMEYER DR
Mailing Address - Street 2:SUITE CC
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937-2213
Mailing Address - Country:US
Mailing Address - Phone:920-922-6640
Mailing Address - Fax:
Practice Address - Street 1:1211 RICKMEYER DR
Practice Address - Street 2:SUITE CC
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937-2213
Practice Address - Country:US
Practice Address - Phone:920-922-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1444-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist