Individual
KATHRYN MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
612 N RANDALL AVE, JANESVILLE, WI 53545-1958
(608) 725-7660
Mailing address
612 N RANDALL AVE, JANESVILLE, WI 53545-1958
(608) 725-7660
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
17772
WI
101YP2500X
Professional Counselor
Primary
3056-226
WI
Other
Enumeration date
05/20/2016
Last updated
06/08/2016
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