Provider Demographics
NPI:1417722000
Name:GIRDEEN, KALLIE RENEE (APSW, MSW, IDP-AT)
Entity Type:Individual
Prefix:
First Name:KALLIE
Middle Name:RENEE
Last Name:GIRDEEN
Suffix:
Gender:F
Credentials:APSW, MSW, IDP-AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 29TH AVE NE APT 4
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-1012
Mailing Address - Country:US
Mailing Address - Phone:715-928-2345
Mailing Address - Fax:
Practice Address - Street 1:4076 KOTHLOW AVE
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-3090
Practice Address - Country:US
Practice Address - Phone:715-928-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134417104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker