Healthcare Provider Details

I. General information

NPI: 1225811904
Provider Name (Legal Business Name): KARI GELDERNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 FORDEM AVE
MADISON WI
53704-4600
US

IV. Provider business mailing address

25 KESSEL CT STE 105
MADISON WI
53711-6227
US

V. Phone/Fax

Practice location:
  • Phone: 608-280-2700
  • Fax:
Mailing address:
  • Phone: 608-280-2700
  • Fax:

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 Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: