Individual
KATHLEEN M HERBISON KISTING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
100 POLK COUNTY PLZ, SUITE 50, BALSAM LAKE, WI 54810-9071
(715) 485-8463
(715) 485-8490
Mailing address
2834 22ND ST, RICE LAKE, WI 54868-9752
(715) 234-9833
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
775 132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
372795
MHN HMC INSURANCE
WI
05
—
39345700
—
WI
01
—
663731021639
PREFERREDONE INSURANCE
WI
Enumeration date
04/11/2007
Last updated
07/09/2007
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