Healthcare Provider Details

I. General information

NPI: 1306558820
Provider Name (Legal Business Name): KATHRYN M DAGGETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 WILLIAMSTOWNE STE 101
DELAFIELD WI
53018-2332
US

IV. Provider business mailing address

383 WILLIAMSTOWNE STE 101
DELAFIELD WI
53018-2332
US

V. Phone/Fax

Practice location:
  • Phone: 262-337-9770
  • Fax: 262-337-9771
Mailing address:
  • Phone: 262-337-9770
  • Fax: 262-337-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10077-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: