Individual
MS. KATHERINE M THEADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
10400 W NORTH AVE, SUITE 495, WAUWATOSA, WI 53226-2425
(414) 777-3178
(414) 777-3204
Mailing address
10400 W NORTH AVE, SUITE 495, WAUWATOSA, WI 53226-2425
(414) 777-3178
(414) 777-3204
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1421
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41005100
—
WI
Enumeration date
08/31/2006
Last updated
07/09/2007
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