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NPI Code Detail

MEDICARE: KATHLEEN AYALA LCSW

MEDICARE: KATHLEEN AYALA LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker128071-121WI
21041C0700XClinical Social Worker9996-123WI

General Provider Information

NPI Number : 1538727656
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN AYALA LCSW
Provider Business Mailing Address
First Line : 383 WILLIAMSTOWNE STE 101
Second Line :
City : DELAFIELD
State : WI
Zip : 53018-2332
Country : US
Telephone Number : 262-337-9770
Fax Number : 262-337-9771
Provider Business Practice Location Address
First Line : 383 WILLIAMSTOWNE STE 101
Second Line :
City : DELAFIELD
State : WI
Zip : 53018-2332
Country : US
Telephone Number : 262-337-9770
Fax Number : 262-337-9771
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2019
Last Update Date : 08/11/2022

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Directions to “ KATHLEEN AYALA LCSW” Practice Location

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