Individual
KATHRYN P VANDUSARTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS LPC
Contact information
Practice address
412 W KINNE ST, ELLSWORTH, WI 54011
(715) 273-6770
(715) 273-6862
Mailing address
PO BOX 670, ELLSWORTH, WI 54011-0670
(715) 273-6770
(715) 273-6862
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2663-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09G64HA
BLUE CROSS BLUE SHIELD
MN
05
—
39748600
—
WI
01
—
920461021644
PREFERRED ONE
MN
01
—
HP70350
HEALTHPARTNERS
MN
Enumeration date
11/15/2006
Last updated
07/09/2007
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