| Doctor Name: | MS. LISA MARIE BLAKEN-MILLER |
| NPI Number: | 1073724233 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 3289125 |
| Business Practice Address: | N9710 State Hwy 108 Melrose, WI - 546428258 |
| Business Phone Number: | 6083861086 |
| Business Fax Number: | 6084882161 |
| Mailing Address: | N9710 State Hwy 108, MELROSE |
| State: | WI |
| Postal Code: | 546428258 |
| Phone Number: | 6083861086 |
| Fax Number: | 6084882161 |
| NPI Enumeration Date: | 05/26/2007 |
| NPI Last Update Date: | 10/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 3289125 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |