Provider Demographics
NPI:1780981043
Name:CONDON, KATHRYN E (LPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:CONDON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 N SHERMAN AVE # 106
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4236
Mailing Address - Country:US
Mailing Address - Phone:608-695-9915
Mailing Address - Fax:608-230-5682
Practice Address - Street 1:406 N PINCKNEY ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-1410
Practice Address - Country:US
Practice Address - Phone:608-695-9915
Practice Address - Fax:608-255-8837
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3530 125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor