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General NPI Number Information
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NPI Number | 1619834769
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Entity Type | Individual
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Provider Name | AVA RADEKE ALLROGGEN M.S., LPC-IT
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Gender | Female
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 345 FRENETTE DR STE 4
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-3072
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Country | US
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Telephone | 715-861-7762
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Fax |
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Provider Business Mailing Address
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Address Line | 702 4TH ST E
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City | MENOMONIE
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State | WI
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Zip | 54751-2528
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Country | US
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Telephone | 763-614-9744
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8841226
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License Number State | WI
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