Provider Demographics
NPI:1306052295
Name:KAISER, REBECCA ANNA (MS, LMFT)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANNA
Last Name:KAISER
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:ANNA
Other - Last Name:BARTHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:317 DEWITT ST
Mailing Address - Street 2:PO BOX 445
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-2155
Mailing Address - Country:US
Mailing Address - Phone:608-566-3812
Mailing Address - Fax:608-745-1757
Practice Address - Street 1:317 DE WITT ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-2155
Practice Address - Country:US
Practice Address - Phone:608-566-3812
Practice Address - Fax:608-745-1757
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI837-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43730800Medicaid