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General NPI Number Information
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NPI Number | 1255431870
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Entity Type | Individual
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Provider Name | LISA ANN WITKOWSKI MPAS, PA-C, LPC
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Gender | Female
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 1121 BELLWEST BLVD
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City | BELLEVILLE
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State | WI
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Zip | 53508-9433
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Country | US
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Telephone | 608-424-3384
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Fax |
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Provider Business Mailing Address
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Address Line | 7974 UW HEALTH CT
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City | MIDDLETON
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State | WI
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Zip | 53562-5531
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 4213-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4213-125
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7951-23
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 7951
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License Number State | WI
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