Provider Demographics
NPI:1932365574
Name:SCHINKE, KELLY JUNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JUNE
Last Name:SCHINKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7109 GLEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-8108
Mailing Address - Country:US
Mailing Address - Phone:920-213-8881
Mailing Address - Fax:
Practice Address - Street 1:602 WALDOCH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8445
Practice Address - Country:US
Practice Address - Phone:920-213-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2697-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical