Healthcare Provider Details

I. General information

NPI: 1487450177
Provider Name (Legal Business Name): CARRI ANN CISKE LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRI ANN CAPPAERT

II. Dates (important events)

Enumeration Date: 02/22/2025
Last Update Date: 02/22/2025
Certification Date: 02/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W7086 MANITOWOC RD
MENASHA WI
54952-9411
US

IV. Provider business mailing address

W7086 MANITOWOC RD
MENASHA WI
54952-9411
US

V. Phone/Fax

Practice location:
  • Phone: 920-809-7140
  • Fax:
Mailing address:
  • Phone: 920-809-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8318-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: