Female

Ms. Kathleen G. Koepke MSSW, LICSW

Mental Health Counselor in Wautoma, WI(View on Map)

Full Name

Ms. Kathleen Gussler Koepke MSSW, LICSW

NPI Number

1295834539

NPI Type

Individual Provider

Gender

Female

Enumeration Date

09/22/2006

Specialties

(Taxonomies)

Code

101YM0800X
1041C0700X

Primary Taxonomy

Yes
No

Licenses

State

Wisconsin
Wisconsin

License Number

2337
2337-123

Contact
Information

Purpose

Mailing
Location

Address

230 PARK ST
230 W PARK ST

City

Wautoma
Wautoma

State

WI
WI

Postal Code

54982-9031
54982-9031

Country

US
US

Telephone Number

(920) 787-6550
(920) 787-6550

Identifiers

Identifier

39654800
84306005

Identifier State

WI
WI

Identifier Issuer

Unknown
MEDICARE

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 07/09/2015

Provider Address

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