1649167594 NPI number — KATHERINE BALTHAZOR MS, LPC, CRC

Table of content: KATHERINE BALTHAZOR MS, LPC, CRC (NPI 1649167594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649167594 NPI number — KATHERINE BALTHAZOR MS, LPC, CRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALTHAZOR
Provider First Name:
KATHERINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC, CRC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THORNTON
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LPC, CRC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649167594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6580 MONONA DR # 1078
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONONA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53716-4032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6580 MONONA DR # 1078
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONONA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53716-4032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-616-0271
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  5613-125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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