Individual
KELLY THOMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5471 W WATERFORD LN, APPLETON, WI 54913-8510
(920) 731-7445
(920) 731-7490
Mailing address
1835 E EDGEWOOD DR STE 105-540, APPLETON, WI 54913-9407
(920) 731-7445
(920) 882-2946
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5455-125
WI
Other
Enumeration date
06/20/2014
Last updated
07/15/2022
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