Provider Demographics
NPI:1457597932
Name:PIKALEK, GERALDINE REBECCA (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:REBECCA
Last Name:PIKALEK
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MISS
Other - First Name:JERI
Other - Middle Name:REBECCA
Other - Last Name:SWIONTEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:1040 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3174
Mailing Address - Country:US
Mailing Address - Phone:414-476-9675
Mailing Address - Fax:414-615-0627
Practice Address - Street 1:1040 S 70TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-3174
Practice Address - Country:US
Practice Address - Phone:414-476-9675
Practice Address - Fax:414-615-0627
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WI4501-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI104100000XMedicaid