Provider Demographics
NPI:1396044244
Name:BOKNEVITZ, MICHELLE (MS, PC-IT, SAC-IT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BOKNEVITZ
Suffix:
Gender:F
Credentials:MS, PC-IT, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W VIRGINIA ST
Mailing Address - Street 2:ATLAS BUILDING, SUITE 203
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1500
Mailing Address - Country:US
Mailing Address - Phone:414-831-4500
Mailing Address - Fax:
Practice Address - Street 1:600 W VIRGINIA ST
Practice Address - Street 2:ATLAS BUILDING, SUITE 203
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-1500
Practice Address - Country:US
Practice Address - Phone:414-831-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16267-130101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor