Provider Demographics
NPI:1487450177
Name:CISKE, CARRI ANN (LPC-IT)
Entity type:Individual
Prefix:
First Name:CARRI
Middle Name:ANN
Last Name:CISKE
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:CARRI
Other - Middle Name:ANN
Other - Last Name:CAPPAERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W7086 MANITOWOC RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-9411
Mailing Address - Country:US
Mailing Address - Phone:920-809-7140
Mailing Address - Fax:
Practice Address - Street 1:W7086 MANITOWOC RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-9411
Practice Address - Country:US
Practice Address - Phone:920-809-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8318-226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor