Provider Demographics
NPI:1083265961
Name:ROHLIK, KRYSTEN
Entity Type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:
Last Name:ROHLIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17424 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5370
Mailing Address - Country:US
Mailing Address - Phone:715-382-3751
Mailing Address - Fax:
Practice Address - Street 1:17424 109TH AVE
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5370
Practice Address - Country:US
Practice Address - Phone:715-382-3751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4429-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4429-125OtherSTATE LICENSURE