Individual
MS. KATHERINE LUCAS TACKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
436 SUMMIT AVE, OCONOMOWOC, WI 53066-3749
(262) 719-3841
(262) 567-5560
Mailing address
436 SUMMIT AVE, OCONOMOWOC, WI 53066-3749
(262) 719-3841
(262) 567-5560
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7560-123
WI
Other
Enumeration date
09/16/2009
Last updated
09/16/2009
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