Healthcare Provider Details

I. General information

NPI: 1346158730
Provider Name (Legal Business Name): MIKAYLA MLSNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 FOREST LN
MONTELLO WI
53949-9390
US

IV. Provider business mailing address

300 N WISCONSIN ST
BERLIN WI
54923-1153
US

V. Phone/Fax

Practice location:
  • Phone: 608-297-7617
  • Fax:
Mailing address:
  • Phone: 715-650-7130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: