| Doctor Name: | KATHLEEN M HERBISON KISTING |
| NPI Number: | 1427271147 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CSAC |
| License Number: | 775 132 |
| Business Practice Address: | 100 Polk County Plz Suite 50 Balsam Lake, WI - 548109071 |
| Business Phone Number: | 7154858463 |
| Business Fax Number: | 7154858490 |
| Mailing Address: | 2834 22nd St, RICE LAKE |
| State: | WI |
| Postal Code: | 548689752 |
| Phone Number: | 7152349833 |
| Fax Number: | |
| NPI Enumeration Date: | 04/11/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 775 132 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |