Provider Demographics
NPI:1194183731
Name:CONRAD, KAZ (MA, LPC-IT)
Entity Type:Individual
Prefix:
First Name:KAZ
Middle Name:
Last Name:CONRAD
Suffix:
Gender:M
Credentials:MA, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-1940
Mailing Address - Country:US
Mailing Address - Phone:608-495-9500
Mailing Address - Fax:
Practice Address - Street 1:348 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1940
Practice Address - Country:US
Practice Address - Phone:608-495-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2845-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional