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NPI Code Detail

MEDICARE: MS. KRISTINE KAYE BURNSTAD MSW,LCSW

MEDICARE: MS. KRISTINE KAYE BURNSTAD MSW,LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker6780123WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467410001
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KRISTINE KAYE BURNSTAD MSW,LCSW
Provider Business Mailing Address
First Line : 1002 LINCOLN AVE
Second Line : PAUQUETTE CENTER
City : BARABOO
State : WI
Zip : 53913
Country : US
Telephone Number : 608-356-9055
Fax Number : 608-356-5447
Provider Business Practice Location Address
First Line : 1002 LINCOLN AVE
Second Line :
City : BARABOO
State : WI
Zip : 53913-1808
Country : US
Telephone Number : 608-356-9884
Fax Number : 608-356-0985
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 07/08/2007

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