Provider Demographics
NPI:1972237931
Name:SHIPLEY, MIKAYLA NOEL
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:NOEL
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 N ASTOR ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1544
Mailing Address - Country:US
Mailing Address - Phone:262-622-2528
Mailing Address - Fax:
Practice Address - Street 1:2802 COHO ST STE 203
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4521
Practice Address - Country:US
Practice Address - Phone:608-291-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling