Healthcare Provider Details

I. General information

NPI: 1487124848
Provider Name (Legal Business Name): MRS. KATHLEEN N HUSKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E LONGVIEW DR STE B
APPLETON WI
54911-2102
US

IV. Provider business mailing address

420 E LONGVIEW DR STE B
APPLETON WI
54911-2102
US

V. Phone/Fax

Practice location:
  • Phone: 920-543-5583
  • Fax:
Mailing address:
  • Phone: 920-543-5583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: