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General NPI Number Information
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NPI Number | 1346677432
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Entity Type | Individual
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Provider Name | KATE BROCKMAN ATR, LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/18/2018
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Provider Practice Location Address
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Address Line | 1716 FORDEM AVE
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City | MADISON
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State | WI
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Zip | 53704-4604
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Country | US
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Telephone | 608-221-3511
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Fax | 608-221-3514
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Provider Business Mailing Address
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Address Line | 1325 W QUARTZ ST APT 204
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City | BUTTE
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State | MT
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Zip | 59701-8905
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Country | US
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Telephone | 608-214-9392
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7078-125
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License Number State | WI
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