Organization
LUMOS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAITLYN KENEALY LPC (OWNER)
(612) 790-6230
Entity
Organization
Contact information
Practice address
131 S MAIN ST STE M05, FOND DU LAC, WI 54935-4386
(920) 659-5414
Mailing address
131 S MAIN ST STE M05, FOND DU LAC, WI 54935-4386
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/13/2024
Last updated
03/13/2024
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