Provider Demographics
NPI:1083003826
Name:WILKE, MICHELLE A (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:WILKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 N PARK DRIVE LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1603
Mailing Address - Country:US
Mailing Address - Phone:920-749-2390
Mailing Address - Fax:920-749-2399
Practice Address - Street 1:2809 N PARK DRIVE LN
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1603
Practice Address - Country:US
Practice Address - Phone:920-749-2390
Practice Address - Fax:920-749-2399
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional