Provider Demographics
NPI:1154836039
Name:ROBATCEK, KRISTEN KIMBLE (LPT-CIT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KIMBLE
Last Name:ROBATCEK
Suffix:
Gender:F
Credentials:LPT-CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 BRAUND ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8556
Mailing Address - Country:US
Mailing Address - Phone:608-785-7000
Mailing Address - Fax:608-785-7477
Practice Address - Street 1:206 S ROOSEVELT RD STE 124
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-8810
Practice Address - Country:US
Practice Address - Phone:715-670-8692
Practice Address - Fax:608-785-7477
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7628-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7628-125OtherLICENSE
WI100074034Medicaid