Provider Demographics
NPI:1033541016
Name:KUPIETZ, KATIE LYNN (MSOM, DIPL AC,LAC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:KUPIETZ
Suffix:
Gender:F
Credentials:MSOM, DIPL AC,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1145
Mailing Address - Country:US
Mailing Address - Phone:262-721-8101
Mailing Address - Fax:
Practice Address - Street 1:343 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1145
Practice Address - Country:US
Practice Address - Phone:262-721-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI757-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist