Provider Demographics
NPI:1326108457
Name:KOHL, GERMAINE MARIE (MED LCSW LPC)
Entity Type:Individual
Prefix:MRS
First Name:GERMAINE
Middle Name:MARIE
Last Name:KOHL
Suffix:
Gender:F
Credentials:MED LCSW LPC
Other - Prefix:
Other - First Name:GERI
Other - Middle Name:MARIE
Other - Last Name:KOHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:843 E HERMITAGE RD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:WI
Mailing Address - Zip Code:53217
Mailing Address - Country:US
Mailing Address - Phone:414-351-1584
Mailing Address - Fax:
Practice Address - Street 1:12690 W NORTH AVE
Practice Address - Street 2:ELMBROOK FAMILY COUNSELING CENTER
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-785-9188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33221231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical