Individual
KATHY ANNE HERZOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
11518 N PORT WASHINGTON RD STE 202, MEQUON, WI 53092-3443
(262) 244-6177
(262) 299-3040
Mailing address
1035 W GLEN OAKS LN STE 110, MEQUON, WI 53092-3392
(262) 244-6177
(262) 299-3040
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3764-226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100075289
—
WI
Enumeration date
02/06/2018
Last updated
09/09/2021
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