Individual
FAYA KACOS-SHIU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4536 22ND AVE, KENOSHA, WI 53140-5917
(262) 656-0044
(262) 649-1977
Mailing address
4006 WASHINGTON RD, KENOSHA, WI 53144-4819
(262) 656-0044
(262) 649-1977
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
149.019790
IL
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
11502123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100321033
—
WI
05
—
366006600
—
IL
Enumeration date
03/05/2015
Last updated
03/02/2026
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