Provider Demographics
NPI:1578020129
Name:FELDMAN, COLETTE L (LCSW)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:L
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BAY VIEW RD STE C
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1770
Mailing Address - Country:US
Mailing Address - Phone:262-789-1191
Mailing Address - Fax:262-363-7289
Practice Address - Street 1:400 BAY VIEW RD STE C
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1770
Practice Address - Country:US
Practice Address - Phone:262-789-1191
Practice Address - Fax:262-363-7289
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8269-123101YM0800X
WI8269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional