Provider Demographics
NPI:1891985719
Name:RANDALL, KEVIN CARL (MSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:CARL
Last Name:RANDALL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 WALL STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718
Mailing Address - Country:US
Mailing Address - Phone:608-274-8294
Mailing Address - Fax:608-274-8783
Practice Address - Street 1:5310 WALL STREET
Practice Address - Street 2:SUITE 500
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718
Practice Address - Country:US
Practice Address - Phone:608-274-8294
Practice Address - Fax:608-274-8783
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical