Provider Demographics
NPI:1447829874
Name:GATTUSO, KALA (LCSW)
Entity type:Individual
Prefix:
First Name:KALA
Middle Name:
Last Name:GATTUSO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N14W23777 STONE RIDGE DR STE 135
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1164
Mailing Address - Country:US
Mailing Address - Phone:262-299-5455
Mailing Address - Fax:
Practice Address - Street 1:N14W23777 STONE RIDGE DR STE 135
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1164
Practice Address - Country:US
Practice Address - Phone:414-446-0751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130433121104100000X
113471041C0700X
WI113471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker