Healthcare Provider Details

I. General information

NPI: 1518310150
Provider Name (Legal Business Name): KAREN ERICA KERSTING PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 E NORTH AVE COLUMBIA ST MARYS FAMILY MEDICINE
MILWAUKEE WI
53212-3515
US

IV. Provider business mailing address

1121 E NORTH AVE COLUMBIA ST MARYS FAMILY MEDICINE
MILWAUKEE WI
53212-3515
US

V. Phone/Fax

Practice location:
  • Phone: 414-267-6502
  • Fax: 414-267-3892
Mailing address:
  • Phone: 414-267-6502
  • Fax: 414-267-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3395-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: