Provider Demographics
NPI:1689026965
Name:CREEKMORE, MIKHAELA K (APSW)
Entity Type:Individual
Prefix:MS
First Name:MIKHAELA
Middle Name:K
Last Name:CREEKMORE
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 S. RIVER ST
Mailing Address - Street 2:SUITE 254
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-3863
Mailing Address - Country:US
Mailing Address - Phone:608-755-5260
Mailing Address - Fax:608-755-5267
Practice Address - Street 1:17 S. RIVER ST
Practice Address - Street 2:SUITE 254
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3863
Practice Address - Country:US
Practice Address - Phone:608-755-5260
Practice Address - Fax:608-755-5267
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1297281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical