Provider Demographics
NPI:1619099819
Name:WISCHKI, ANNASTASIA LOUIS (SACI)
Entity Type:Individual
Prefix:
First Name:ANNASTASIA
Middle Name:LOUIS
Last Name:WISCHKI
Suffix:
Gender:F
Credentials:SACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:SAUKVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53080-2103
Mailing Address - Country:US
Mailing Address - Phone:262-536-4162
Mailing Address - Fax:
Practice Address - Street 1:1545 S LAYTON BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-1924
Practice Address - Country:US
Practice Address - Phone:414-671-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15364-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)