Provider Demographics
NPI:1265572077
Name:MCCLUSKEY, ELIZABETH KAHN (MS LPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KAHN
Last Name:MCCLUSKEY
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 N 4TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-2135
Mailing Address - Country:US
Mailing Address - Phone:715-224-2100
Mailing Address - Fax:715-224-2106
Practice Address - Street 1:1218 N 4TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-2135
Practice Address - Country:US
Practice Address - Phone:715-224-2100
Practice Address - Fax:715-224-2106
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2870125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43561300Medicaid