Provider Demographics
NPI:1710740220
Name:DEMUS, KENNAE LIERRA (LPC-IT)
Entity Type:Individual
Prefix:
First Name:KENNAE
Middle Name:LIERRA
Last Name:DEMUS
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 N 1ST ST APT 207
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3911
Mailing Address - Country:US
Mailing Address - Phone:859-797-8913
Mailing Address - Fax:
Practice Address - Street 1:1011 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-3262
Practice Address - Country:US
Practice Address - Phone:414-267-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7782-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional