Provider Demographics
NPI:1205945938
Name:MUESKE, KATHLEEN VIRGINIA (MSE, LPC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:VIRGINIA
Last Name:MUESKE
Suffix:
Gender:F
Credentials:MSE, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 DEERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-2612
Mailing Address - Country:US
Mailing Address - Phone:920-560-4525
Mailing Address - Fax:920-560-6618
Practice Address - Street 1:2323 W EVERETT ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-4749
Practice Address - Country:US
Practice Address - Phone:920-969-5320
Practice Address - Fax:920-969-7975
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3296-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40948400Medicaid
WI3296-125OtherLPC