=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386593598
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RANDALL THERAPEUTIC SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2026
-----------------------------------------------------
Last Update Date | 01/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 ANN ST
-----------------------------------------------------
City | RICE LAKE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54868-2265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-736-1000
-----------------------------------------------------
Fax | 715-736-1005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 ANN ST
-----------------------------------------------------
City | RICE LAKE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54868-2265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-736-1000
-----------------------------------------------------
Fax | 715-736-1005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICAL DIRECTOR
-----------------------------------------------------
Name | KIMBERLY NICPON RANDALL
-----------------------------------------------------
Credential | RANDALL
-----------------------------------------------------
Telephone | 715-736-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------