Provider Demographics
NPI:1982220976
Name:RICHARDS, KIRSTEN (MS, LPC, ATR)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MS, LPC, ATR
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:KAAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC, ATR
Mailing Address - Street 1:999 N 92ND ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4875
Mailing Address - Country:US
Mailing Address - Phone:414-266-7615
Mailing Address - Fax:
Practice Address - Street 1:4655 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1004
Practice Address - Country:US
Practice Address - Phone:414-292-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8425-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100102354Medicaid