Provider Demographics
NPI:1609112788
Name:LINDSEY, KATHLEEN (MA, PC-IT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LINDSEY
Suffix:
Gender:F
Credentials:MA, PC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S 8TH ST
Mailing Address - Street 2:STE. 210
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4463
Mailing Address - Country:US
Mailing Address - Phone:920-323-2188
Mailing Address - Fax:920-358-5970
Practice Address - Street 1:615 S 8TH ST
Practice Address - Street 2:STE. 220
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4463
Practice Address - Country:US
Practice Address - Phone:920-323-2188
Practice Address - Fax:920-358-5970
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1384-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional