Healthcare Provider Details

I. General information

NPI: 1467163550
Provider Name (Legal Business Name): JENNIFER ANN KALISTA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JENNIFER ANN LINN

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N 6TH ST
SHEBOYGAN WI
53081-4113
US

IV. Provider business mailing address

1338 WESTWOOD LN
MANITOWOC WI
54220-1602
US

V. Phone/Fax

Practice location:
  • Phone: 920-457-8866
  • Fax:
Mailing address:
  • Phone: 920-242-0520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11026
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7194-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: