Provider Demographics
NPI:1235213562
Name:HICKEY, KATHLEEN LARKIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LARKIN
Last Name:HICKEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 N CASS ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3908
Mailing Address - Country:US
Mailing Address - Phone:414-278-7980
Mailing Address - Fax:414-278-8299
Practice Address - Street 1:827 N CASS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3908
Practice Address - Country:US
Practice Address - Phone:414-278-7980
Practice Address - Fax:414-278-8299
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2555-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical