Provider Demographics
NPI:1295136828
Name:KINDERMAN, KELLY ROSE (MS MFT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ROSE
Last Name:KINDERMAN
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 HILLCREST CIR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2219
Mailing Address - Country:US
Mailing Address - Phone:608-225-4343
Mailing Address - Fax:608-203-5872
Practice Address - Street 1:5308 VALLEY RIDGE PLZ
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2053
Practice Address - Country:US
Practice Address - Phone:608-203-8646
Practice Address - Fax:608-203-5872
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI356-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist