Provider Demographics
NPI:1124457460
Name:BARTELL, KATIE JANE (MA, LPC, SACIT)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:JANE
Last Name:BARTELL
Suffix:
Gender:F
Credentials:MA, LPC, SACIT
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:JANE
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, SACIT
Mailing Address - Street 1:504 LAKELAND RD
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-3836
Mailing Address - Country:US
Mailing Address - Phone:715-526-5547
Mailing Address - Fax:715-526-5542
Practice Address - Street 1:504 LAKELAND RD
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-3836
Practice Address - Country:US
Practice Address - Phone:715-526-5547
Practice Address - Fax:715-526-5542
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16798-130101YA0400X
WI1767-226101YM0800X
WI5684-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health