Provider Demographics
NPI:1942338637
Name:KOPKA, TOM (LCSW)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:KOPKA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E MASON ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3870
Mailing Address - Country:US
Mailing Address - Phone:414-224-3737
Mailing Address - Fax:414-224-3725
Practice Address - Street 1:600 E MASON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3870
Practice Address - Country:US
Practice Address - Phone:414-224-3737
Practice Address - Fax:414-224-3725
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3267-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical