Provider Demographics
NPI:1235467697
Name:BARTELT, KATHERINE M (L AC)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:M
Last Name:BARTELT
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:BARTELT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L AC
Mailing Address - Street 1:212 N CUDD AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-2530
Mailing Address - Country:US
Mailing Address - Phone:715-377-7377
Mailing Address - Fax:651-389-5950
Practice Address - Street 1:2165 WOODLANE DR
Practice Address - Street 2:102
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2915
Practice Address - Country:US
Practice Address - Phone:651-356-9160
Practice Address - Fax:651-389-5950
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1387171100000X
WI520055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist