Provider Demographics
NPI:1376393652
Name:REATEGUI DEWITT, KRISHA KAY (MSW)
Entity Type:Individual
Prefix:
First Name:KRISHA
Middle Name:KAY
Last Name:REATEGUI DEWITT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KRISHA
Other - Middle Name:KAY
Other - Last Name:DEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7633 GANSER WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2092
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7633 GANSER WAY STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2092
Practice Address - Country:US
Practice Address - Phone:608-688-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134487-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker