Organization
RUSS KINKADE PSY D SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL WILLIAM KINKADE JR. PSY.D. (PRESIDENT)
(262) 989-5228
Entity
Organization
Contact information
Practice address
6214 WASHINGTON AVE, C-10, MOUNT PLEASANT, WI 53406-3986
(262) 989-5228
(262) 878-9285
Mailing address
S55W29307 HOLIDAY POINT DR, WAUKESHA, WI 53189-9026
(262) 989-5228
(262) 878-9285
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1296
WI
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
01/27/2015
Last updated
08/01/2025
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