Provider Demographics
NPI:1063288835
Name:LINDSTADT, LORI ANN
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:LINDSTADT
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 1:530 SOUTHTOWNE DR APT V203
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-4190
Mailing Address - Country:US
Mailing Address - Phone:262-339-4078
Mailing Address - Fax:
Practice Address - Street 1:530 SOUTHTOWNE DR APT V203
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-4190
Practice Address - Country:US
Practice Address - Phone:262-339-4078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst