Provider Demographics
NPI:1588057244
Name:MIELKE, AARON (SAC-IT)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:MIELKE
Suffix:
Gender:M
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 S ANDERSON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3447
Mailing Address - Country:US
Mailing Address - Phone:715-369-7300
Mailing Address - Fax:715-369-7301
Practice Address - Street 1:158 S ANDERSON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3447
Practice Address - Country:US
Practice Address - Phone:715-369-7300
Practice Address - Fax:715-369-7301
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16864-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)