Provider Demographics
NPI:1225797137
Name:CATHERINE, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:CATHERINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4524 W. ROOSEVELT DRIVE
Mailing Address - Street 2:#2
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2458
Mailing Address - Country:US
Mailing Address - Phone:414-345-0134
Mailing Address - Fax:
Practice Address - Street 1:4524 W. ROOSEVELT DRIVE
Practice Address - Street 2:#2
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2458
Practice Address - Country:US
Practice Address - Phone:414-345-0134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator