Provider Demographics
NPI:1740588615
Name:ISENSEE, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ISENSEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-3228
Mailing Address - Country:US
Mailing Address - Phone:608-785-6101
Mailing Address - Fax:
Practice Address - Street 1:300 4TH ST N
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-3228
Practice Address - Country:US
Practice Address - Phone:608-785-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32977400Medicaid