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NPI Code Detail

MEDICARE: KRISTEN LOUISE RADTKE LPC-IT, CMI

MEDICARE: KRISTEN LOUISE RADTKE LPC-IT, CMI
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
1101YP2500XProfessional Counselor2653-226WI

General Provider Information

NPI Number : 1609244763
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN LOUISE RADTKE LPC-IT, CMI
Provider Business Mailing Address
First Line : 429 GAMMON PL
Second Line : SUITE 200
City : MADISON
State : WI
Zip : 53719-1053
Country : US
Telephone Number : 815-520-6023
Fax Number : 608-821-0938
Provider Business Practice Location Address
First Line : 429 GAMMON PL
Second Line : SUITE 200
City : MADISON
State : WI
Zip : 53719-1053
Country : US
Telephone Number : 815-520-6023
Fax Number : 608-821-0938
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2015
Last Update Date : 07/21/2016

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Directions to “ KRISTEN LOUISE RADTKE LPC-IT, CMI” Practice Location

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