Provider Demographics
NPI:1619345014
Name:MCGARY, KOLETTE
Entity Type:Individual
Prefix:
First Name:KOLETTE
Middle Name:
Last Name:MCGARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KOLETTE
Other - Middle Name:
Other - Last Name:BOHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:880 INDEPENDENCE LN
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-1381
Mailing Address - Country:US
Mailing Address - Phone:608-644-3233
Mailing Address - Fax:
Practice Address - Street 1:880 INDEPENDENCE LN
Practice Address - Street 2:
Practice Address - City:SAUK CITY
Practice Address - State:WI
Practice Address - Zip Code:53583-1381
Practice Address - Country:US
Practice Address - Phone:608-644-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI618-156231H00000X
IL147001569231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist