Provider Demographics
NPI:1598044331
Name:LUEDKE, JOEL (MSE, ATC/L, CSCS)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:LUEDKE
Suffix:
Gender:M
Credentials:MSE, ATC/L, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 WELL ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2452
Mailing Address - Country:US
Mailing Address - Phone:507-261-4097
Mailing Address - Fax:
Practice Address - Street 1:1620 WELL ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2452
Practice Address - Country:US
Practice Address - Phone:507-261-4097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer