Provider Demographics
NPI:1922142355
Name:THOME, KATHLEEN KIM (MSED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:KIM
Last Name:THOME
Suffix:
Gender:F
Credentials:MSED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6710 GREENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-8675
Mailing Address - Country:US
Mailing Address - Phone:815-535-7399
Mailing Address - Fax:
Practice Address - Street 1:40 JEWELERS PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3893
Practice Address - Country:US
Practice Address - Phone:920-486-4288
Practice Address - Fax:920-486-4287
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5646101YM0800X, 101YP2500X
IL178.002173101YM0800X
IL1776001101YS0200X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool