Kolstad, Dale M

Kolstad, Dale M is an individual health care provider with primary practice located at 200 E La Crosse St Juneau County Human Services, Mauston WI 53948-2101. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Social Worker. Behavioral Health & Social Service Providers / Professional is his primary health care specialty. Kolstad, Dale M can be contacted via phone (608) 847-2400.

Contact Information

Primary practice address
200 E La Crosse St Juneau County Human Services Mauston WI 53948-2101
Phone: (608) 847-2400
Fax: (608) 847-9599
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 1016125 Wisconsin
Behavioral Health & Social Service Providers / Social Worker 104100000X 4042123 Wisconsin

Profile Details

NPI number 1427016955
LBN Legal business name Kolstad, Dale M
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date May 3rd, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427016955 NPPES
Wisconsin MEDICAID 39218500

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