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General NPI Number Information
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NPI Number | 1649291923
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Entity Type | Individual
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Provider Name | KALPANA RAO PHD
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Gender | Female
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 6123 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53142-2927
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Country | US
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Telephone | 262-948-1000
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Fax | 262-942-9374
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Provider Business Mailing Address
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Address Line | PO BOX 7814
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City | GURNEE
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State | IL
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Zip | 60031-7005
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Country | US
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Telephone | 262-948-1000
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Fax | 262-942-9374
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1918-057
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License Number State | WI
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