Provider Demographics
NPI:1013650746
Name:MASKE, KATIE L (CSAC, ICS-IT)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:L
Last Name:MASKE
Suffix:
Gender:F
Credentials:CSAC, ICS-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-2027
Mailing Address - Country:US
Mailing Address - Phone:715-748-3332
Mailing Address - Fax:
Practice Address - Street 1:540 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-2027
Practice Address - Country:US
Practice Address - Phone:715-748-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)