Provider Demographics
NPI:1952310625
Name:BANDSTRA, KATHY L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:L
Last Name:BANDSTRA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:LYNN
Other - Last Name:BANDSTRA
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-647-6326
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:10400 75TH ST
Practice Address - Street 2:#307
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-8323
Practice Address - Country:US
Practice Address - Phone:262-948-6770
Practice Address - Fax:262-948-6788
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6867-1231041C0700X
WI640-1241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical