Individual
KATHLEEN COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2639 NEW PINERY RD STE 1, PORTAGE, WI 53901-1110
(608) 742-5020
(608) 742-3641
Mailing address
2639 NEW PINERY RD STE 1, PORTAGE, WI 53901-1110
(608) 742-5020
(608) 742-3641
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
656-124
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40919600
—
WI
Enumeration date
09/13/2006
Last updated
07/08/2007
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