Basic Information
| Provider Information | |||||||||
| NPI: | 1659318871 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELBEL | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PROF MENTAL HLTH TEC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | OTT | ||||||||
| OtherFirstName: | LISA | ||||||||
| OtherMiddleName: | LYNN | ||||||||
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| OtherCredential: | PROF MENTAL HLTH TEC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 220 E LA CROSSE ST | ||||||||
| Address2: | JUNEAU COUNTY HUMAN SERVICES | ||||||||
| City: | MAUSTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539482101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088472400 | ||||||||
| FaxNumber: | 6088479599 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 E LA CROSSE ST | ||||||||
| Address2: | JUNEAU COUNTY HUMAN SERVICES | ||||||||
| City: | MAUSTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539482101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088472400 | ||||||||
| FaxNumber: | 6088479599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 09/08/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.