Individual provider Active NPI

Grace Marie Lischka, MS, LAT, ATC

  • Athletic Trainer
  • Manitowoc, WI
National Provider Identifier
1861353161
Registry record updated Nov 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
330839 Issued in WI
Practice address
4045 Lancer Cir
Manitowoc, WI 54220-2336
Phone
(920) 682-0215
NPI assigned
Nov 18, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 330839 WI Primary

Addresses

Primary practice location

4045 Lancer Cir
Manitowoc, WI 54220-2336

Mailing address

2473 Portside LN Apt 19
Manitowoc, WI 54220-3421
Phone (920) 901-5586

Other names 1

  • Grace Marie Melso Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
330839WIMDAthletic Trainer

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1763424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763424000000",
    "number": "1861353161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2473 PORTSIDE LN APT 19",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542203421",
            "telephone_number": "920-901-5586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 LANCER CIR",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542202336",
            "telephone_number": "920-682-0215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISCHKA",
        "first_name": "GRACE",
        "middle_name": "MARIE",
        "credential": "MS, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-11-18",
        "last_updated": "2025-11-18",
        "certification_date": "2025-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "330839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRACE",
            "last_name": "MELSO",
            "middle_name": "MARIE",
            "credential": "MS, LAT, ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Manitowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.