Provider Demographics
NPI:1285923870
Name:WISNESKI, MICHELLE
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:WISNESKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:KLASSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1068 SANDPOINT RDG
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-5639
Mailing Address - Country:US
Mailing Address - Phone:920-574-5946
Mailing Address - Fax:
Practice Address - Street 1:821 E 1ST AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1586
Practice Address - Country:US
Practice Address - Phone:920-257-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127-3605381101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health