Healthcare Provider Details

I. General information

NPI: 1407793706
Provider Name (Legal Business Name): MICHELE LUKES-KRAUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CHICAGO ST
DE PERE WI
54115-3418
US

IV. Provider business mailing address

N9413 ROSEBUD LN
APPLETON WI
54915-7453
US

V. Phone/Fax

Practice location:
  • Phone: 920-619-1555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number210117
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: