Healthcare Provider Details

I. General information

NPI: 1871899641
Provider Name (Legal Business Name): KATHY OBRYANT MSSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934A N 2ND ST
MILWAUKEE WI
53212-3709
US

IV. Provider business mailing address

1934A N 2ND ST
MILWAUKEE WI
53212-3709
US

V. Phone/Fax

Practice location:
  • Phone: 414-915-1683
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number944122
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: