Provider Demographics
NPI:1750681409
Name:KRISIK, KATE ALLISON (MS, SLP, CFY)
Entity Type:Individual
Prefix:MS
First Name:KATE
Middle Name:ALLISON
Last Name:KRISIK
Suffix:
Gender:F
Credentials:MS, SLP, CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W580 COUNTY ROAD HH
Mailing Address - Street 2:
Mailing Address - City:MONDOVI
Mailing Address - State:WI
Mailing Address - Zip Code:54755-7721
Mailing Address - Country:US
Mailing Address - Phone:715-225-9794
Mailing Address - Fax:
Practice Address - Street 1:W580 COUNTY ROAD HH
Practice Address - Street 2:
Practice Address - City:MONDOVI
Practice Address - State:WI
Practice Address - Zip Code:54755-7721
Practice Address - Country:US
Practice Address - Phone:715-225-9794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3383-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3383-154OtherSPEECH-LANGUAGE PATHOLOGY WISCONSIN LICENSE