Healthcare Provider Details

I. General information

NPI: 1982946364
Provider Name (Legal Business Name): KATHRYN J POPE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN POPE COCHRAN LCSW

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 N SUMMIT AVE STE 111
MILWAUKEE WI
53202-1362
US

IV. Provider business mailing address

1314 S 1ST ST # 135
MILWAUKEE WI
53204-2405
US

V. Phone/Fax

Practice location:
  • Phone: 312-757-0300
  • Fax:
Mailing address:
  • Phone: 312-757-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-06342
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.021042
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11254-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: