Provider Demographics
NPI:1518318278
Name:EKERN, CATHY MARIE (LPC MA)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:MARIE
Last Name:EKERN
Suffix:
Gender:F
Credentials:LPC MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-2736
Mailing Address - Country:US
Mailing Address - Phone:715-234-1654
Mailing Address - Fax:
Practice Address - Street 1:246 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SHELL LAKE
Practice Address - State:WI
Practice Address - Zip Code:54871-8889
Practice Address - Country:US
Practice Address - Phone:715-468-2841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2019-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health