Provider Demographics
NPI:1457709909
Name:MAZEIKA, KATELYN MARIE RYAN (MSW, CAPSW, CBIS)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:MARIE RYAN
Last Name:MAZEIKA
Suffix:
Gender:F
Credentials:MSW, CAPSW, CBIS
Other - Prefix:MS
Other - First Name:KATELYN
Other - Middle Name:MARIE
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, CAPSW, CBIS
Mailing Address - Street 1:6100 W STATE ST
Mailing Address - Street 2:APT. 313
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2983
Mailing Address - Country:US
Mailing Address - Phone:651-271-6738
Mailing Address - Fax:
Practice Address - Street 1:945 N 12TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1305
Practice Address - Country:US
Practice Address - Phone:651-271-6738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24914104100000X
WI129421104100000X
MN9407101041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool