Provider Demographics
NPI:1609244763
Name:RADTKE, KRISTEN LOUISE (LPC-IT, CMI)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LOUISE
Last Name:RADTKE
Suffix:
Gender:F
Credentials:LPC-IT, CMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 GAMMON PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1053
Mailing Address - Country:US
Mailing Address - Phone:815-520-6023
Mailing Address - Fax:608-821-0938
Practice Address - Street 1:429 GAMMON PL
Practice Address - Street 2:SUITE 200
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1053
Practice Address - Country:US
Practice Address - Phone:815-520-6023
Practice Address - Fax:608-821-0938
Is Sole Proprietor?:No
Enumeration Date:2015-09-07
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2653-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional