Provider Demographics
NPI:1336658202
Name:KUSSLER, KAREN OAKLAY (SAC-IT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:OAKLAY
Last Name:KUSSLER
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-9007
Mailing Address - Country:US
Mailing Address - Phone:262-370-2170
Mailing Address - Fax:
Practice Address - Street 1:5325 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1623
Practice Address - Country:US
Practice Address - Phone:414-810-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-23
Last Update Date:2017-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18273-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI18273-130OtherSTATE LICENSE