Healthcare Provider Details

I. General information

NPI: 1639073570
Provider Name (Legal Business Name): MARIA ELENA LODENKAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

3908 WOODLAND RD APT 10
GREEN BAY WI
54313-8149
US

IV. Provider business mailing address

2133 FOX POINT CIR
DE PERE WI
54115-3316
US

V. Phone/Fax

Practice location:
  • Phone: 920-737-9518
  • Fax:
Mailing address:
  • Phone: 920-737-9518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: