Provider Demographics
NPI:1023301231
Name:O'CONNOR, KATHLEEN PATRICIA (MS, LPC, ATR)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:PATRICIA
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MS, LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 E KANE PL
Mailing Address - Street 2:#64
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1760
Mailing Address - Country:US
Mailing Address - Phone:414-466-9450
Mailing Address - Fax:414-466-0730
Practice Address - Street 1:3801 N 88TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2706
Practice Address - Country:US
Practice Address - Phone:414-466-9450
Practice Address - Fax:414-466-0730
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4536-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health