Healthcare Provider Details

I. General information

NPI: 1962560136
Provider Name (Legal Business Name): KATHLEEN ANN RYSER-DONNELLY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10045 W LISBON AVE 302
WAUWATOSA WI
53222-2446
US

IV. Provider business mailing address

906 E WATERFORD AVE #2
MILWAUKEE WI
53207-4562
US

V. Phone/Fax

Practice location:
  • Phone: 414-358-7144
  • Fax: 414-358-7158
Mailing address:
  • Phone: 414-294-0341
  • Fax: 414-294-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6754123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: