Provider Demographics
NPI:1558874180
Name:KESTING, SAMANTHA B (LPC-IT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:B
Last Name:KESTING
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:DENTICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6511
Mailing Address - Country:US
Mailing Address - Phone:800-438-1772
Mailing Address - Fax:262-293-9737
Practice Address - Street 1:112 PEACE LUTHERAN PKWY
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-1159
Practice Address - Country:US
Practice Address - Phone:800-438-1772
Practice Address - Fax:262-293-9737
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8406-125101YP2500X
WI3741-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100073005Medicaid