Provider Demographics
NPI:1992365886
Name:SCHWAFFEL, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:SCHWAFFEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:SCHWALBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 E OLIN AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1434
Mailing Address - Country:US
Mailing Address - Phone:608-280-3150
Mailing Address - Fax:608-237-2690
Practice Address - Street 1:3821 NAKOMA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-3015
Practice Address - Country:US
Practice Address - Phone:920-279-2088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11950-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker