Provider Demographics
NPI:1104337880
Name:ARNOLD, KATRINA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:ARNOLD
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:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-0959
Mailing Address - Country:US
Mailing Address - Phone:715-544-4435
Mailing Address - Fax:715-952-4995
Practice Address - Street 1:1466 WATER ST STE 2
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-2915
Practice Address - Country:US
Practice Address - Phone:715-341-6672
Practice Address - Fax:715-341-8004
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1104337880Medicaid