Provider Demographics
NPI:1679740559
Name:FLODSTROM, KARIN ESTHER (PSYD)
Entity type:Individual
Prefix:DR
First Name:KARIN
Middle Name:ESTHER
Last Name:FLODSTROM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1309
Mailing Address - Country:US
Mailing Address - Phone:262-643-4612
Mailing Address - Fax:
Practice Address - Street 1:423 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1309
Practice Address - Country:US
Practice Address - Phone:262-643-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-10
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2917-57103TC0700X
IL071.004132103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical