Provider Demographics
NPI:1992240709
Name:PAULSEN, KRISTI (MS, SAC-IT)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:MS, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 LESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8694
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:575 LESTER AVE STE 100
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8695
Practice Address - Country:US
Practice Address - Phone:608-783-1452
Practice Address - Fax:608-783-1456
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6858101YP2500X
WI17886101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100045005Medicaid