Provider Demographics
NPI:1568936946
Name:KACZMAREK, JULIANNE M (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:M
Last Name:KACZMAREK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:M
Other - Last Name:GENNERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:721 AMERICAN AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5071
Mailing Address - Country:US
Mailing Address - Phone:262-928-4036
Mailing Address - Fax:
Practice Address - Street 1:721 AMERICAN AVE STE 501
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5071
Practice Address - Country:US
Practice Address - Phone:262-928-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI96241041C0700X
WI7764104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker