Healthcare Provider Details

I. General information

NPI: 1861569295
Provider Name (Legal Business Name): KRISTINE A FEGGESTAD MS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SOUTH 8TH ST STE 620 NORTHSHORE CLINIC OF SHEBOYGAN INC
SHEBOYGAN WI
53081
US

IV. Provider business mailing address

615 SOUTH 8TH ST STE 620 NORTHSHORE CLINIC OF SHEBOYGAN INC
SHEBOYGAN WI
53081
US

V. Phone/Fax

Practice location:
  • Phone: 920-457-8866
  • Fax: 920-457-8867
Mailing address:
  • Phone: 920-457-8866
  • Fax: 920-457-8867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3807
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: