Most Relevant Information
Provider Data
| NPI Number: | 1003401118 |
| Provider Name: | MARISSA A MIELKE |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/02/2021 |
| Last Updated: | 03/02/2021 |
Provider Practice Location
14 TRI PARK WAY BLDG 2
APPLETON
WI
549146445
Practice Location Phone/Fax
| Phone: | 9208094125 |
| Fax: |
Provider Mailing Location
5154 JUNIPER LN
OSHKOSH
WI
549049702
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |