Provider Demographics
NPI:1871054221
Name:HARWOOD, KATHLEEN L (LPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:HARWOOD
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 1:409 N MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:WI
Mailing Address - Zip Code:53502-9526
Mailing Address - Country:US
Mailing Address - Phone:608-436-0506
Mailing Address - Fax:
Practice Address - Street 1:6705 WESNER RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-9178
Practice Address - Country:US
Practice Address - Phone:608-620-3486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7038-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1376913129OtherTYPE 2