Provider Demographics
NPI:1851475867
Name:KUYKENDALL, KATHY S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:S
Last Name:KUYKENDALL
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 1:1500 W MAIN STREET
Mailing Address - Street 2:STE 300B
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590
Mailing Address - Country:US
Mailing Address - Phone:608-825-6711
Mailing Address - Fax:608-834-6499
Practice Address - Street 1:1500 W MAIN STREET
Practice Address - Street 2:STE 300B
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590
Practice Address - Country:US
Practice Address - Phone:608-825-6711
Practice Address - Fax:608-834-6499
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31391231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39266300Medicaid