Healthcare Provider Details

I. General information

NPI: 1245159508
Provider Name (Legal Business Name): MICHAELA LEIGH MEDRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 39TH AVE
KENOSHA WI
53144-2738
US

IV. Provider business mailing address

7810 W LAKE POINTE DR
FRANKLIN WI
53132-8529
US

V. Phone/Fax

Practice location:
  • Phone: 262-447-8999
  • Fax: 262-404-8833
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9196-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: