Provider Demographics
NPI:1467513580
Name:ISTRE, KATHLEEN (PHD LP)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:ISTRE
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 16TH ST NE
Mailing Address - Street 2:#2
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-2156
Mailing Address - Country:US
Mailing Address - Phone:320-894-0955
Mailing Address - Fax:
Practice Address - Street 1:640 ATLANTIC AVE
Practice Address - Street 2:COUNSELING ASSOCIATES
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215-1381
Practice Address - Country:US
Practice Address - Phone:320-843-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3914103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist