Provider Demographics
NPI:1710356548
Name:KEDROWSKI, LINDA B (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:B
Last Name:KEDROWSKI
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:BERNICE
Other - Last Name:RUETHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-389-0781
Mailing Address - Fax:
Practice Address - Street 1:2450 VINEYARD DR
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-3973
Practice Address - Country:US
Practice Address - Phone:715-342-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WI6752-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker