Provider Demographics
NPI:1780404533
Name:WEIS, KATHARINE M (MFT-IT)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:M
Last Name:WEIS
Suffix:
Gender:F
Credentials:MFT-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 CENTURY AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2030
Mailing Address - Country:US
Mailing Address - Phone:608-213-4203
Mailing Address - Fax:
Practice Address - Street 1:6601 GRAND TETON PLZ STE B3
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1056
Practice Address - Country:US
Practice Address - Phone:608-213-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1100228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist