Provider Demographics
NPI:1174644348
Name:CLARK-SETNES, KRISTINE LOUISE (MS, LMFT, ATR)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:LOUISE
Last Name:CLARK-SETNES
Suffix:
Gender:F
Credentials:MS, LMFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53008-0410
Mailing Address - Country:US
Mailing Address - Phone:262-641-3700
Mailing Address - Fax:262-641-3719
Practice Address - Street 1:W5297 YOUNG ROAD
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:WI
Practice Address - Zip Code:53119-1908
Practice Address - Country:US
Practice Address - Phone:262-392-5558
Practice Address - Fax:262-982-2569
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34036221700000X
WI192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist