MEDICARE: ANNASTASIA LOUIS WISCHKI LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	15364-130	WI
2	101YP2500X	Professional Counselor	4402-125	WI

General Provider Information

NPI Number	:	1619099819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNASTASIA LOUIS WISCHKI LPC

Provider Business Mailing Address
First Line	:	W206N16747 BLACKBERRY CIR UNIT 1702
Second Line	:
City	:	JACKSON
State	:	WI
Zip	:	53037-9029
Country	:	US
Telephone Number	:	262-505-2280
Fax Number	:

Provider Business Practice Location Address
First Line	:	W206N16747 BLACKBERRY CIR UNIT 1702
Second Line	:
City	:	JACKSON
State	:	WI
Zip	:	53037-9029
Country	:	US
Telephone Number	:	262-505-2280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	11/14/2025

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