Provider Demographics
NPI:1104096189
Name:MITTELSTEADT, SANDRA LEE (LPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:MITTELSTEADT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 ESTHER ANN LN
Mailing Address - Street 2:
Mailing Address - City:HORTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54944-2402
Mailing Address - Country:US
Mailing Address - Phone:715-281-2610
Mailing Address - Fax:
Practice Address - Street 1:4321 W COLLEGE AVE STE 200
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3968
Practice Address - Country:US
Practice Address - Phone:920-358-0118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4398-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional