Provider Demographics
NPI:1861830481
Name:REISER, KATHRYN M (ATR, LPC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:M
Last Name:REISER
Suffix:
Gender:F
Credentials:ATR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10304 W NORTH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2429
Mailing Address - Country:US
Mailing Address - Phone:414-248-9388
Mailing Address - Fax:
Practice Address - Street 1:2625 S GREELEY ST STE 205
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-2027
Practice Address - Country:US
Practice Address - Phone:414-248-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4960-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional