Healthcare Provider Details

I. General information

NPI: 1548359888
Provider Name (Legal Business Name): KATHALEEN L DAU MS CADCIII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HALL AVE SUITE A MARINETTE COUNTY HEALTH AND HUMAN SERVICES
MARINETTE WI
54143
US

IV. Provider business mailing address

2500 HALL AVE SUITE A MARINETTE COUNTY HEALTH AND HUMAN SERVICES
MARINETTE WI
54143
US

V. Phone/Fax

Practice location:
  • Phone: 715-732-7760
  • Fax: 715-732-7711
Mailing address:
  • Phone: 715-732-7760
  • Fax: 715-732-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2552125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2552125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: