Provider Demographics
NPI:1124798533
Name:KALSOW, LIDIA (RDN)
Entity type:Individual
Prefix:MRS
First Name:LIDIA
Middle Name:
Last Name:KALSOW
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2898 COUNTY ROAD OO
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53085-2986
Mailing Address - Country:US
Mailing Address - Phone:920-901-4086
Mailing Address - Fax:
Practice Address - Street 1:N2898 COUNTY ROAD OO
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085-2986
Practice Address - Country:US
Practice Address - Phone:920-901-4086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86069393133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered