Individual
MS. KATHLEEN GUSSLER KOEPKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSSW, LICSW
Contact information
Practice address
230 W PARK ST, WAUTOMA, WI 54982-9031
(920) 787-6550
(920) 787-0421
Mailing address
230 PARK ST, PO BOX 1230, WAUTOMA, WI 54982-9031
(920) 787-6550
(920) 787-0421
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2337
WI
1041C0700X
Clinical Social Worker
2337-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39654800
—
WI
01
—
84306005
MEDICARE
WI
Enumeration date
09/22/2006
Last updated
07/09/2015
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