Healthcare Provider Details

I. General information

NPI: 1588190607
Provider Name (Legal Business Name): HEATHER N MIKKELSON LCSW,CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5471 W WATERFORD LN
APPLETON WI
54913-8510
US

IV. Provider business mailing address

5337 W GRANDE MARKET DR
APPLETON WI
54913-8442
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-7445
  • Fax:
Mailing address:
  • Phone: 920-731-7445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9240-123
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: