Basic Information
| Provider Information | |||||||||
| NPI: | 1174644348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLARK-SETNES | ||||||||
| FirstName: | KRISTINE | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | MS, LMFT, ATR | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 410 | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530080410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626413700 | ||||||||
| FaxNumber: | 2626413719 | ||||||||
| Practice Location | |||||||||
| Address1: | W5297 YOUNG ROAD | ||||||||
| Address2: | |||||||||
| City: | EAGLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531191908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623925558 | ||||||||
| FaxNumber: | 2629822569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 221700000X | 34036 | WI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | 106H00000X | 192 | WI | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.