Healthcare Provider Details

I. General information

NPI: 1659291326
Provider Name (Legal Business Name): CHAD KLINE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 W INNOVATION DR
MILWAUKEE WI
53226-4825
US

IV. Provider business mailing address

10200 W INNOVATION DR
MILWAUKEE WI
53226-4825
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-1040
  • Fax: 414-307-1583
Mailing address:
  • Phone: 414-955-1040
  • Fax: 414-307-1583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13042-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: