Provider Demographics
NPI:1932672003
Name:TOLTZIEN, KELLY J (MS, ATR, LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:TOLTZIEN
Suffix:
Gender:F
Credentials:MS, ATR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 RAY O VAC DR STE 320
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2471
Mailing Address - Country:US
Mailing Address - Phone:608-520-0846
Mailing Address - Fax:
Practice Address - Street 1:700 RAY O VAC DR STE 320
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2471
Practice Address - Country:US
Practice Address - Phone:608-520-0846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6990-125101YP2500X
221700000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist