Provider Demographics
NPI:1144044777
Name:HATCHER, KELAH FOREST (MSW)
Entity type:Individual
Prefix:
First Name:KELAH
Middle Name:FOREST
Last Name:HATCHER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450A N DOUSMAN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3040
Mailing Address - Country:US
Mailing Address - Phone:715-419-0956
Mailing Address - Fax:
Practice Address - Street 1:3365 S 103RD ST STE 100
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4162
Practice Address - Country:US
Practice Address - Phone:414-321-3951
Practice Address - Fax:414-321-8307
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11933-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical