Individual
MRS. KATHLEEN FENNO MCNULTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
1220 MOUND AVE, SUITE 301, RACINE, WI 53404-3350
(262) 633-3591
(262) 633-2619
Mailing address
1220 MOUND AVE, SUITE 301, RACINE, WI 53404-3350
(262) 633-3591
(262) 633-2619
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7210-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40984300
—
WI
Enumeration date
08/05/2006
Last updated
07/08/2007
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