Healthcare Provider Details

I. General information

NPI: 1043677016
Provider Name (Legal Business Name): KATE GEMIGNANI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATE O'CONNOR LCSW

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 05/26/2024
Certification Date: 05/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 DRESSER DR STE 100
JANESVILLE WI
53546-9160
US

IV. Provider business mailing address

4700 DRESSER DR STE 100
JANESVILLE WI
53546-9160
US

V. Phone/Fax

Practice location:
  • Phone: 608-752-7255
  • Fax:
Mailing address:
  • Phone: 608-752-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11736123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: