Provider Demographics
NPI:1164651311
Name:JUECH, ALLISON MARGARET (PA)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:MARGARET
Last Name:JUECH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:MARGARET
Other - Last Name:GRADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 26428
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-0428
Mailing Address - Country:US
Mailing Address - Phone:414-647-5203
Mailing Address - Fax:
Practice Address - Street 1:3201 S 16TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4537
Practice Address - Country:US
Practice Address - Phone:414-647-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2442-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant