Provider Demographics
NPI:1568153799
Name:KRYCH, KATRINA RAE (APSW)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:RAE
Last Name:KRYCH
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:RAE
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4722 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-1450
Mailing Address - Country:US
Mailing Address - Phone:608-215-5255
Mailing Address - Fax:
Practice Address - Street 1:4722 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-1450
Practice Address - Country:US
Practice Address - Phone:608-215-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI133042104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1568153799Medicaid