Provider Demographics
NPI:1932142197
Name:RUSSELL, CATHERINE A (MSW, LCSW, DCSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:A
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MSW, LCSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23423 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:KANSASVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53139-9726
Mailing Address - Country:US
Mailing Address - Phone:262-878-2638
Mailing Address - Fax:
Practice Address - Street 1:VA CLINIC
Practice Address - Street 2:21425 SPRING
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182
Practice Address - Country:US
Practice Address - Phone:262-878-7011
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2857-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical