Provider Demographics
NPI:1285032565
Name:GLICK, KATHLEEN CLAIRE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CLAIRE
Last Name:GLICK
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 JEWELERS PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3893
Mailing Address - Country:US
Mailing Address - Phone:920-521-7133
Mailing Address - Fax:920-521-7134
Practice Address - Street 1:40 JEWELERS PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3893
Practice Address - Country:US
Practice Address - Phone:920-521-7133
Practice Address - Fax:920-521-7134
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6133-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional