MEDICARE: MRS. KIRSTAN CARROLL BEATTY

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
1	101YP2500X	Professional Counselor		WI

General Provider Information

NPI Number	:	1821930454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIRSTAN CARROLL BEATTY

Provider Business Mailing Address
First Line	:	414 BROADWAY ST STE 101
Second Line	:
City	:	BARABOO
State	:	WI
Zip	:	53913-2488
Country	:	US
Telephone Number	:	608-393-2381
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 BROADWAY ST STE 101
Second Line	:
City	:	BARABOO
State	:	WI
Zip	:	53913-2488
Country	:	US
Telephone Number	:	608-393-2381
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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