Healthcare Provider Details

I. General information

NPI: 1770133555
Provider Name (Legal Business Name): KERRIN SENDROWITZ O'CONNOR PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KERRIN SENDROWITZ

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 S OUTAGAMIE ST
APPLETON WI
54914-5580
US

IV. Provider business mailing address

1509 S OUTAGAMIE ST
APPLETON WI
54914-5580
US

V. Phone/Fax

Practice location:
  • Phone: 518-698-3103
  • Fax:
Mailing address:
  • Phone: 518-698-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number020475
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: