Healthcare Provider Details

I. General information

NPI: 1659601201
Provider Name (Legal Business Name): KARA SUE BADER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 STRATFORD CT
RACINE WI
53406-7003
US

IV. Provider business mailing address

981 STRATFORD CT
RACINE WI
53406-7003
US

V. Phone/Fax

Practice location:
  • Phone: 815-291-0005
  • Fax:
Mailing address:
  • Phone: 815-291-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: