Provider Demographics
NPI:1376826214
Name:MICHALS, KATELYN RUTH (LAC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:RUTH
Last Name:MICHALS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 N PORT WASHINGTON RD STE 320
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1077
Mailing Address - Country:US
Mailing Address - Phone:414-839-4349
Mailing Address - Fax:
Practice Address - Street 1:4650 N PORT WASHINGTON RD STE 330
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1077
Practice Address - Country:US
Practice Address - Phone:414-839-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI742-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist