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General NPI Number Information
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NPI Number | 1386056166
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Entity Type | Individual
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Provider Name | JACQUELINE KUESTER
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Gender | Female
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 1104 21ST ST STE E
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City | REEDSBURG
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State | WI
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Zip | 53959-1156
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Country | US
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Telephone | 608-768-4545
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Fax | 608-768-4646
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Provider Business Mailing Address
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Address Line | 1550 W PINE ST APT 505
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City | BARABOO
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State | WI
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Zip | 53913-9515
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Country | US
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Telephone | 224-330-8092
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Fax | 608-768-4646
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16536-130
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1950-226
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License Number State | WI
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