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General NPI Number Information
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NPI Number | 1598087058
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Entity Type | Individual
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Provider Name | LISA O'DONNELL KJOS M.S., M.S.E, ED.S.
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Gender | Female
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 2923 MARKETPLACE DR
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City | FITCHBURG
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State | WI
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Zip | 53719-5319
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Country | US
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Telephone | 608-602-8883
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Fax |
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Provider Business Mailing Address
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Address Line | 516 FORD DR UNIT B
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City | BARNEVELD
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State | WI
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Zip | 53507-9435
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Country | US
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Telephone | 608-346-5234
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 11062-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 62616466
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7103-226
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License Number State | WI
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