Physician Compare National (NPI:1134613656)

HEALTHCARE PROVIDER: KATHERINE DIANE COLLINS LCSW 06/13-18

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1134613656
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2264771690
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190304000202
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	COLLINS
	Individual professional last name
Provider First Name	KATHERINE
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2013
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	647 W MAIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 900
	Group Practice or individual's line 2 address
City	LAKE GENEVA
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	531471985
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y