Individual
KATELYN MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
7610 PERSHING BLVD, KENOSHA, WI 53142-4318
(262) 948-3600
Mailing address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-5600
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4014-154
WI
Other
Enumeration date
09/19/2014
Last updated
09/19/2014
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