MEDICARE: DR. KELLY JUNE SCHINKE PSY.D.

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	103TC0700X	Clinical Psychologist	2697-057	WI

General Provider Information

NPI Number	:	1932365574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY JUNE SCHINKE PSY.D.

Provider Business Mailing Address
First Line	:	W7109 GLEN VALLEY DR
Second Line	:
City	:	GREENVILLE
State	:	WI
Zip	:	54942-8108
Country	:	US
Telephone Number	:	920-213-8881
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 WALDOCH DR
Second Line	:	SUITE 100
City	:	APPLETON
State	:	WI
Zip	:	54913-8445
Country	:	US
Telephone Number	:	920-213-8881
Fax Number	:

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

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	02/02/2012

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