Individual
KATHERINE DIANE COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW 06/13-18
Contact information
Practice address
400 BAY VIEW RD STE C, MUKWONAGO, WI 53149-1770
(262) 789-1191
(262) 363-7289
Mailing address
N7269 COLBO RD, BURLINGTON, WI 53105-2525
(262) 749-8687
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8942-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42170300
—
WI
Enumeration date
06/18/2018
Last updated
06/18/2018
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