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General NPI Number Information
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NPI Number | 1023027414
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Entity Type | Individual
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Provider Name | KATHLEEN FENNO MCNULTY L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1220 MOUND AVE SUITE 301
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City | RACINE
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State | WI
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Zip | 53404-3350
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Country | US
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Telephone | 262-633-3591
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Fax | 262-633-2619
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Provider Business Mailing Address
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Address Line | 1220 MOUND AVE SUITE 301
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City | RACINE
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State | WI
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Zip | 53404-3350
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Country | US
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Telephone | 262-633-3591
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Fax | 262-633-2619
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7210-123
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License Number State | WI
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