Provider Demographics
NPI:1528224383
Name:DIONNE, KATHLEEN R (MS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:DIONNE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10532 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5563
Mailing Address - Country:US
Mailing Address - Phone:262-242-3810
Mailing Address - Fax:262-242-3816
Practice Address - Street 1:10532 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5563
Practice Address - Country:US
Practice Address - Phone:262-242-3810
Practice Address - Fax:262-242-3816
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI788-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI788-266OtherSTATE OF WISCONSIN