Provider Demographics
NPI:1891876553
Name:MISCHKA, TAMARA SUE (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:SUE
Last Name:MISCHKA
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E BELL ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4993
Mailing Address - Country:US
Mailing Address - Phone:920-969-1768
Mailing Address - Fax:920-486-6710
Practice Address - Street 1:515 S WASHBURN ST STE 200
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7975
Practice Address - Country:US
Practice Address - Phone:920-969-1768
Practice Address - Fax:920-267-5222
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI278-156231H00000X
231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41132300Medicaid
WI00071415Medicare PIN