Healthcare Provider Details

I. General information

NPI: 1861682221
Provider Name (Legal Business Name): VALERIE ANASTASIA CARROLL PAC, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 S HOWELL AVE STE 700
OAK CREEK WI
53154-5000
US

IV. Provider business mailing address

2051 ALLEN BLVD APT 403
MIDDLETON WI
53562-3492
US

V. Phone/Fax

Practice location:
  • Phone: 608-270-5656
  • Fax:
Mailing address:
  • Phone: 630-890-3930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2899
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17006-146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: