Provider Demographics
NPI:1710681820
Name:DUNCAN, KADEESHA D
Entity Type:Individual
Prefix:
First Name:KADEESHA
Middle Name:D
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 W NATIONAL AVE
Mailing Address - Street 2:BUILDING 43 FLOOR 3 (A320)
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53295
Mailing Address - Country:US
Mailing Address - Phone:414-629-0923
Mailing Address - Fax:
Practice Address - Street 1:5000 W NATIONAL AVE BUILDING 43 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:MILWUAKEE
Practice Address - State:WI
Practice Address - Zip Code:53295
Practice Address - Country:US
Practice Address - Phone:262-909-8812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI805695104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker