Provider Demographics
NPI:1669932356
Name:HARDY, KATHRYN ROSE (CAPSW, SAC-IT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSE
Last Name:HARDY
Suffix:
Gender:F
Credentials:CAPSW, SAC-IT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ROSE
Other - Last Name:BOOKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAPSW, SAC-IT
Mailing Address - Street 1:5461 CADDIS BND
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7119
Mailing Address - Country:US
Mailing Address - Phone:224-616-4862
Mailing Address - Fax:
Practice Address - Street 1:700 REGENT ST STE 300
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-2634
Practice Address - Country:US
Practice Address - Phone:224-616-4862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health