Healthcare Provider Details

I. General information

NPI: 1275378556
Provider Name (Legal Business Name): KATHLEEN CAULEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N3045 COUNTY ROAD J
FORT ATKINSON WI
53538-9703
US

IV. Provider business mailing address

N3045 COUNTY ROAD J
FORT ATKINSON WI
53538-9703
US

V. Phone/Fax

Practice location:
  • Phone: 920-728-0520
  • Fax:
Mailing address:
  • Phone: 920-728-0520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number125-1742
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number125-1742
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: