Individual
KATHLEEN ROSE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5555 N PORT WASHINGTON RD STE 200, GLENDALE, WI 53217-4927
(262) 789-1191
Mailing address
2459 N 83RD ST, WAUWATOSA, WI 53213-1024
(414) 507-4730
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9613-123
WI
Other
Enumeration date
02/17/2021
Last updated
02/17/2021
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