Provider Demographics
NPI:1922323054
Name:MISKOWIAK, CHRISTINE MARIE (MS, CRC, LPC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:MISKOWIAK
Suffix:
Gender:F
Credentials:MS, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 DORCHESTER WAY
Mailing Address - Street 2:5
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4326
Mailing Address - Country:US
Mailing Address - Phone:608-333-5521
Mailing Address - Fax:
Practice Address - Street 1:3142 DORCHESTER WAY
Practice Address - Street 2:5
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-4326
Practice Address - Country:US
Practice Address - Phone:608-333-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI464226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI464226OtherTRAINING LICENSE FOR PROFESSIONAL COUNSELING
00097560OtherCERTIFICATION IN REHABILITATION COUNSELING