Provider Demographics
NPI:1437265113
Name:KAHLSTORF, HEIDI LYNN (LMFT)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:LYNN
Last Name:KAHLSTORF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:HEIDI
Other - Middle Name:KAHLSTORF
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:MEMORIAL MEDICAL CENTER INC
Mailing Address - Street 2:1635 MAPLE LANE
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3610
Mailing Address - Country:US
Mailing Address - Phone:715-585-5400
Mailing Address - Fax:715-685-5102
Practice Address - Street 1:MEMORIAL MEDICAL CENTER INC
Practice Address - Street 2:1635 MAPLE LANE
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3610
Practice Address - Country:US
Practice Address - Phone:715-585-5400
Practice Address - Fax:715-685-5102
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1615106H00000X
WI1147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1000006920Medicaid