Healthcare Provider Details

I. General information

NPI: 1346807211
Provider Name (Legal Business Name): KALIE GEITNER MS, LPC, SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 BROADWAY ST # 480
BARABOO WI
53913-2183
US

IV. Provider business mailing address

505 BROADWAY ST # 480
BARABOO WI
53913-2183
US

V. Phone/Fax

Practice location:
  • Phone: 608-355-4200
  • Fax: 608-355-4299
Mailing address:
  • Phone: 608-355-4200
  • Fax: 608-355-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11646-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: