Provider Demographics
NPI:1033756796
Name:BADEAU, KATRINA (LMFT)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:BADEAU
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-1533
Mailing Address - Country:US
Mailing Address - Phone:262-501-4774
Mailing Address - Fax:
Practice Address - Street 1:N3219 COUNTY H STE E
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-7074
Practice Address - Country:US
Practice Address - Phone:262-261-1409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI653-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist