Healthcare Provider Details

I. General information

NPI: 1982220976
Provider Name (Legal Business Name): KIRSTEN RICHARDS MS, LPC, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTEN KAAT MS, LPC, ATR

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 N PORT WASHINGTON RD
GLENDALE WI
53212-1004
US

IV. Provider business mailing address

999 N 92ND ST
WAUWATOSA WI
53226-4875
US

V. Phone/Fax

Practice location:
  • Phone: 414-292-4242
  • Fax:
Mailing address:
  • Phone: 414-266-7615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8425-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: