Provider Demographics
NPI:1144004292
Name:LEWELLYN, KATRINA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:LEWELLYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 SWANTON RD APT 1
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-1967
Mailing Address - Country:US
Mailing Address - Phone:608-448-8915
Mailing Address - Fax:
Practice Address - Street 1:2976 TRIVERTON PIKE DR # 207
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5840
Practice Address - Country:US
Practice Address - Phone:608-448-8915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional