Provider Demographics
NPI:1174299150
Name:HETKE, KATRINA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:HETKE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 CASHMAN DR
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-3543
Mailing Address - Country:US
Mailing Address - Phone:715-861-1058
Mailing Address - Fax:
Practice Address - Street 1:234 CASHMAN DR
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3543
Practice Address - Country:US
Practice Address - Phone:715-861-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9320-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical