Provider Demographics
NPI:1760520050
Name:SCHENK, MICHELE E (MA, CP, CSAC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:E
Last Name:SCHENK
Suffix:
Gender:F
Credentials:MA, CP, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 PEACE PIPE RD
Mailing Address - Street 2:PO BOX189
Mailing Address - City:LAC DU FLAMBEAU
Mailing Address - State:WI
Mailing Address - Zip Code:54538-0189
Mailing Address - Country:US
Mailing Address - Phone:715-588-1511
Mailing Address - Fax:715-588-3903
Practice Address - Street 1:533 PEACE PIPE RD
Practice Address - Street 2:
Practice Address - City:LAC DU FLAMBEAU
Practice Address - State:WI
Practice Address - Zip Code:54538-0189
Practice Address - Country:US
Practice Address - Phone:715-588-1511
Practice Address - Fax:715-588-3903
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17230-130101YA0400X
WI31078103T00000X
WI16070-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43700100Medicaid