Healthcare Provider Details

I. General information

NPI: 1538943832
Provider Name (Legal Business Name): KATHY L MCRAE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4957 N 25TH ST
MILWAUKEE WI
53209-5618
US

IV. Provider business mailing address

4957 N 25TH ST
MILWAUKEE WI
53209-5618
US

V. Phone/Fax

Practice location:
  • Phone: 414-229-8719
  • Fax: 414-509-5370
Mailing address:
  • Phone: 414-793-5899
  • Fax: 414-509-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number00102586
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: