Provider Demographics
NPI:1013655513
Name:GROFF, KATHRYN C (LMFT-IT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:C
Last Name:GROFF
Suffix:
Gender:F
Credentials:LMFT-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N 4TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-2437
Mailing Address - Country:US
Mailing Address - Phone:920-323-2564
Mailing Address - Fax:
Practice Address - Street 1:101 N 4TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2437
Practice Address - Country:US
Practice Address - Phone:920-323-2564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI817-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist