JACQUELYN LIETKE (NPI# 1225676083) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225676083 |
| Entity Type | Individual |
| Full Name | JACQUELYN LIETKE |
| Credential | LMT |
| Practice Address |
3120 South Ave Ste 105 La Crosse WI 54601-6720 |
| Practice Telephone | 6083175788 |
| Mailing Telephone | 6083175788 |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2019-12-11 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225700000X | Massage Therapist | 10111-146 | WI | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| N | 225700000X | Massage Therapist | WI | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
3120 SOUTH AVE STE 105 |
| City | LA CROSSE |
| State | WI |
| Zip Code | 54601-6720 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891324265 | Meagan Mcrae | Student in an Organized Health Care Education/Training Program | 1725 State St., 4051 Health Science Center, La Crosse, WI 54601 | 2020-04-07 |
| 1255969671 | Erin Dingman | Student in an Organized Health Care Education/Training Program | 1751 State Street, 4051 Health Science Center, La Crosse, WI 54601 | 2020-03-31 |
| 1619505047 | Nicole Kay Lynch | Student in an Organized Health Care Education/Training Program | 4051 Health Science Center, 1725 State St, La Crosse, WI 54601 | 2020-03-31 |
| 1174151757 | Jenna Sells | Student in an Organized Health Care Education/Training Program | 4051 Health Science Center, 1725 State Street, La Crosse, WI 54601 | 2020-03-30 |
| 1740818301 | Katie Irene Tahtinen | Student in an Organized Health Care Education/Training Program | Uwl- 4051 Health Science Center, 1725 State St., La Crosse, WI 54601 | 2020-03-30 |
| 1932737517 | Margaret May Grimm | Student in an Organized Health Care Education/Training Program | Univesity of Wisconsin-la Crosse, 4051 Health Science Center, 1725 State Street, La Crosse, WI 54601 | 2020-03-30 |
| 1831727312 | Matthew Timothy Axler | Student in an Organized Health Care Education/Training Program | 4051 Health Science Center, 1725 State Street, La Crosse, WI 54601 | 2020-03-30 |
| 1093340473 | Denise Stinson | Technician | 1311 Badger St, Apt 505, La Crosse, WI 54601 | 2020-03-06 |
| 1922632397 | Ibrahim Ahsan | Pharmacist | 1105 Wi-16, La Crosse, WI 54601 | 2020-02-25 |
| 1750913356 | Liza R Collins | Massage Therapist | 1415 State Wi 16, La Crosse, WI 54601 | 2020-02-11 |
| Find all providers in zip 54601 | ||||
| Taxonomy Code | 225700000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Massage Therapist |
| An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750913356 | Liza R Collins | Massage Therapist | 1415 State Wi 16, La Crosse, WI 54601 | 2020-02-11 |
| 1912032087 | Sherry Mehlhoff | Massage Therapist | 1415a State Rd 16, La Crosse, WI 54601 | 2007-02-22 |
| 1992327944 | Darlene Kalsem | Massage Therapist | 2837 Darling Ct, La Crosse, WI 54601-2754 | 2020-05-13 |
| 1912529892 | Sage Reisbig | Massage Therapist | 2837 Darling Ct, La Crosse, WI 54601-2754 | 2020-05-13 |
| 1699307157 | Eugena Allen | Massage Therapist | 525 Lang Dr, La Crosse, WI 54603-2946 | 2020-02-12 |
| 1174163257 | Allison Hanson | Massage Therapist | 402 6th St S, La Crosse, WI 54601-4505 | 2020-01-07 |
| 1558901637 | Joyce Strub | Massage Therapist | 402 6th St S, La Crosse, WI 54601-4505 | 2020-01-07 |
| 1811535842 | Colette Sill | Massage Therapist | 402 6th St S, La Crosse, WI 54601-4505 | 2019-12-20 |
| 1225476518 | Victoria Lynn Potaracke | Massage Therapist | 603 King St, La Crosse, WI 54601-4140 | 2013-06-07 |
| 1811247919 | Kelsey Angela Lyons | Massage Therapist | 800 West Ave S, La Crosse, WI 54601-8806 | 2012-09-16 |
| Find all providers in LA CROSSE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.