Healthcare Provider Details

I. General information

NPI: 1902204878
Provider Name (Legal Business Name): CATHERINE LINDSKOG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39610 LAKE PARK CT
GENOA CITY WI
53128-1283
US

IV. Provider business mailing address

1360 REGENT ST STE 133
MADISON WI
53715-1255
US

V. Phone/Fax

Practice location:
  • Phone: 262-902-0692
  • Fax:
Mailing address:
  • Phone: 608-889-7173
  • Fax: 262-757-7543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2312-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: