Individual
MIKAYLA TIDEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
620 S 76TH ST, MILWAUKEE, WI 53214-1599
(414) 292-4242
(414) 453-2538
Mailing address
620 S 76TH ST, MILWAUKEE, WI 53214-1599
(414) 292-4242
(414) 453-2538
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
10312-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790441665
—
WI
Enumeration date
11/15/2021
Last updated
04/22/2026
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