Provider Demographics
NPI:1548359888
Name:DAU, KATHALEEN L (MS CADCIII)
Entity type:Individual
Prefix:
First Name:KATHALEEN
Middle Name:L
Last Name:DAU
Suffix:
Gender:F
Credentials:MS CADCIII
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 HALL AVE
Mailing Address - Street 2:SUITE A MARINETTE COUNTY HEALTH AND HUMAN SERVICES
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143
Mailing Address - Country:US
Mailing Address - Phone:715-732-7760
Mailing Address - Fax:715-732-7711
Practice Address - Street 1:2500 HALL AVE
Practice Address - Street 2:SUITE A MARINETTE COUNTY HEALTH AND HUMAN SERVICES
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143
Practice Address - Country:US
Practice Address - Phone:715-732-7760
Practice Address - Fax:715-732-7711
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2552125101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2552125OtherLICENSE #
WI39348700Medicaid