Healthcare Provider Details

I. General information

NPI: 1114360864
Provider Name (Legal Business Name): KELSEY LEE HUTCHINS L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20700 WATERTOWN RD #102
WAUKESHA WI
53186-1800
US

IV. Provider business mailing address

20700 WATERTOWN RD #102
WAUKESHA WI
53186-1800
US

V. Phone/Fax

Practice location:
  • Phone: 262-782-1474
  • Fax:
Mailing address:
  • Phone: 262-782-1474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5645-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.009718
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: