Provider Demographics
NPI:1033607122
Name:POLLOCK, KIRSTEN (APSW, MSW)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:APSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 OVERLOOK TER
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2254
Mailing Address - Country:US
Mailing Address - Phone:608-280-7085
Mailing Address - Fax:
Practice Address - Street 1:1 SCIENCE CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1055
Practice Address - Country:US
Practice Address - Phone:608-256-1901
Practice Address - Fax:608-284-6375
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126488104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker