Provider Demographics
NPI:1083742951
Name:WALDSCHMIDT, KAYLA MARGARET (MSE)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARGARET
Last Name:WALDSCHMIDT
Suffix:
Gender:F
Credentials:MSE
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:MARGARET
Other - Last Name:LACKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSE
Mailing Address - Street 1:960 MARY LN
Mailing Address - Street 2:APT. 5
Mailing Address - City:LOMIRA
Mailing Address - State:WI
Mailing Address - Zip Code:53048-9569
Mailing Address - Country:US
Mailing Address - Phone:920-360-7062
Mailing Address - Fax:
Practice Address - Street 1:1200 N CENTER ST
Practice Address - Street 2:LOWER LEVEL-SUITE A
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-1166
Practice Address - Country:US
Practice Address - Phone:920-887-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional