Provider Demographics
NPI:1700564382
Name:KATHY J. RUSSETH, M.D., S.C.
Entity Type:Organization
Organization Name:KATHY J. RUSSETH, M.D., S.C.
Other - Org Name:CENTERED PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-305-4150
Mailing Address - Street 1:345 W WASHINGTON AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-6019
Mailing Address - Country:US
Mailing Address - Phone:608-305-4150
Mailing Address - Fax:608-305-8736
Practice Address - Street 1:345 W WASHINGTON AVE STE 307
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-6019
Practice Address - Country:US
Practice Address - Phone:414-395-5435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty