=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407175250
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE ENOS MANDT M.S., M.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2010
-----------------------------------------------------
Last Update Date | 05/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6000 MONONA DR SUITE 203
-----------------------------------------------------
City | MONONA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53716-3327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-223-9767
-----------------------------------------------------
Fax | 608-223-9767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6000 MONONA DR SUITE 203
-----------------------------------------------------
City | MONONA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53716-3327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-223-9767
-----------------------------------------------------
Fax | 608-223-9767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 311792
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------