Provider Demographics
NPI:1861569295
Name:FEGGESTAD, KRISTINE A (MS LPC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:A
Last Name:FEGGESTAD
Suffix:
Gender:F
Credentials:MS LPC
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Other - Credentials:
Mailing Address - Street 1:615 SOUTH 8TH ST STE 620
Mailing Address - Street 2:NORTHSHORE CLINIC OF SHEBOYGAN INC
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081
Mailing Address - Country:US
Mailing Address - Phone:920-457-8866
Mailing Address - Fax:920-457-8867
Practice Address - Street 1:615 SOUTH 8TH ST STE 620
Practice Address - Street 2:NORTHSHORE CLINIC OF SHEBOYGAN INC
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081
Practice Address - Country:US
Practice Address - Phone:920-457-8866
Practice Address - Fax:920-457-8867
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI3807101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health