Provider Demographics
NPI:1467410001
Name:BURNSTAD, KRISTINE KAYE (MSW,LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:KAYE
Last Name:BURNSTAD
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 LINCOLN AVE
Mailing Address - Street 2:PAUQUETTE CENTER
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913
Mailing Address - Country:US
Mailing Address - Phone:608-356-9055
Mailing Address - Fax:608-356-5447
Practice Address - Street 1:1002 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1808
Practice Address - Country:US
Practice Address - Phone:608-356-9884
Practice Address - Fax:608-356-0985
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6780123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43577200Medicaid