Provider Demographics
NPI:1033566088
Name:KAISER, DAKOTA J (PHD)
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:J
Last Name:KAISER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-3492
Mailing Address - Country:US
Mailing Address - Phone:715-848-4884
Mailing Address - Fax:715-845-5398
Practice Address - Street 1:1810 N 2ND ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-3492
Practice Address - Country:US
Practice Address - Phone:715-848-4884
Practice Address - Fax:715-845-5398
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16670-130101YP2500X
WI3006-226101YP2500X
WI3905-57103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional