Healthcare Provider Details

I. General information

NPI: 1063100048
Provider Name (Legal Business Name): KIRSTIN DUPREY QTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 S 8TH ST
MANITOWOC WI
54220-4535
US

IV. Provider business mailing address

926 S 8TH ST
MANITOWOC WI
54220-4535
US

V. Phone/Fax

Practice location:
  • Phone: 920-683-4230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20255-130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: