Provider Demographics
NPI:1649981598
Name:KROENKE, CLAIRE JOANNA (LAC)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:JOANNA
Last Name:KROENKE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2847 S AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2009
Mailing Address - Country:US
Mailing Address - Phone:414-788-8733
Mailing Address - Fax:
Practice Address - Street 1:3101 S DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-3018
Practice Address - Country:US
Practice Address - Phone:414-481-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2004-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty