Individual
JACQUELYN LIETKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3120 SOUTH AVE STE 105, LA CROSSE, WI 54601-6720
(608) 317-5788
Mailing address
3120 SOUTH AVE STE 105, LA CROSSE, WI 54601-6720
(608) 317-5788
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10111-146
WI
225700000X
Massage Therapist
—
WI
Other
Enumeration date
12/11/2019
Last updated
12/11/2019
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