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NPI Code Detail

MEDICARE: MS. KARLA J BIDSTRUP LCSW

MEDICARE: MS. KARLA J BIDSTRUP LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker1410-123WI

General Provider Information

NPI Number : 1437485984
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KARLA J BIDSTRUP LCSW
Provider Business Mailing Address
First Line : 4810 NORTHWESTERN AVE
Second Line :
City : MOUNT PLEASANT
State : WI
Zip : 53406-1504
Country : US
Telephone Number : 262-637-9984
Fax Number :
Provider Business Practice Location Address
First Line : 4810 NORTHWESTERN AVE
Second Line :
City : MOUNT PLEASANT
State : WI
Zip : 53406-1504
Country : US
Telephone Number : 262-637-9984
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2009
Last Update Date : 09/12/2019

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