Provider Demographics
NPI:1942212766
Name:KRISS, CATHRYN ANN (MSSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:ANN
Last Name:KRISS
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6702 STONEFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3875
Mailing Address - Country:US
Mailing Address - Phone:608-836-5529
Mailing Address - Fax:608-836-8059
Practice Address - Street 1:6702 STONEFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3875
Practice Address - Country:US
Practice Address - Phone:608-836-5529
Practice Address - Fax:608-836-8059
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1041C0700X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39244400Medicaid
WI39244400Medicaid