Provider Demographics
NPI:1497828081
Name:HALSTEAD, KATHRYN JANE (MSTOM)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:JANE
Last Name:HALSTEAD
Suffix:
Gender:F
Credentials:MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7904 PATHFINDER PL
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-9135
Mailing Address - Country:US
Mailing Address - Phone:605-721-4580
Mailing Address - Fax:605-721-3944
Practice Address - Street 1:2416 JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3450
Practice Address - Country:US
Practice Address - Phone:605-721-4580
Practice Address - Fax:605-721-4580
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist