Provider Demographics
NPI:1144182759
Name:BORNDAHL, KATHLEEN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BORNDAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S 8TH ST STE G20
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-0001
Mailing Address - Country:US
Mailing Address - Phone:920-226-9599
Mailing Address - Fax:920-783-8422
Practice Address - Street 1:615 S 8TH ST STE G20
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-0001
Practice Address - Country:US
Practice Address - Phone:920-226-9599
Practice Address - Fax:920-783-8422
Is Sole Proprietor?:No
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health