# RUSS KINKADE PSY D SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992195192
- **Authorized official:** DR. RUSSELL WILLIAM KINKADE JR. PSY.D. (PRESIDENT)
- **Authorized official phone:** (262) 989-5228

## Contact information

- **Practice address:** 6214 WASHINGTON AVE, C-10, MOUNT PLEASANT, WI 53406-3986
- **Practice address phone:** (262) 989-5228
- **Practice address fax:** (262) 878-9285
- **Mailing address:** S55W29307 HOLIDAY POINT DR, WAUKESHA, WI 53189-9026
- **Mailing address phone:** (262) 989-5228
- **Mailing address fax:** (262) 878-9285

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 1296 | WI | Yes |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 01/27/2015
- **Last updated:** 08/01/2025