Healthcare Provider Details

I. General information

NPI: 1801707930
Provider Name (Legal Business Name): KATHRYN MAE PETERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN MAE ANSTETT-DEKKER

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S 24TH AVE STE 400
WAUSAU WI
54401-5242
US

IV. Provider business mailing address

1125 GREEN AVE
STEVENS POINT WI
54481-2354
US

V. Phone/Fax

Practice location:
  • Phone: 715-848-1457
  • Fax: 715-848-2959
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8917-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: