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General NPI Number Information
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NPI Number | 1255013264
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Entity Type | Individual
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Provider Name | KATHY JO WITZIG LPC
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Gender | Female
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Dates
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Enumeration Date | 08/01/2023
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 8215 GREENWAY BLVD STE 160
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City | MIDDLETON
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State | WI
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Zip | 53562-3689
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Country | US
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Telephone | 608-236-4460
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Fax | 608-236-4461
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Provider Business Mailing Address
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Address Line | 14884 BREEZY HILL RD
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City | FENNIMORE
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State | WI
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Zip | 53809-9745
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Country | US
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Telephone | 608-732-4855
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1398-125
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License Number State | WI
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