Healthcare Provider Details

I. General information

NPI: 1508701350
Provider Name (Legal Business Name): KATHRYN BAILEY BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 OKEEFFE AVE APT 147
SUN PRAIRIE WI
53590-4142
US

IV. Provider business mailing address

1051 OKEEFFE AVE APT 147
SUN PRAIRIE WI
53590-4142
US

V. Phone/Fax

Practice location:
  • Phone: 920-241-0104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12603-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: