MEDICARE: JACQUELINE CLAUSIUS CATS III

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	081638	CA
2	106H00000X	Marriage & Family Therapist	1321-124	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1649316910	OTHER	CA	DRUG MEDICAL

General Provider Information

NPI Number	:	1659703551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE CLAUSIUS CATS III

Provider Business Mailing Address
First Line	:	3732 W WISCONSIN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-3166
Country	:	US
Telephone Number	:	414-290-0440
Fax Number	:

Provider Business Practice Location Address
First Line	:	3732 W WISCONSIN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-3166
Country	:	US
Telephone Number	:	414-290-0440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	10/24/2020

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