Basic Information
| Provider Information | |||||||||
| NPI: | 1528330784 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KILEY | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MS, LPC, CSAC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GONSTEAD | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | K | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MS, LPC, SAC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 25 KESSEL CT | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537116227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082802645 | ||||||||
| FaxNumber: | 6082802655 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 KESSEL CT | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537116227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082802645 | ||||||||
| FaxNumber: | 6082802655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2012 | ||||||||
| LastUpdateDate: | 08/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 16052-132 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 5447-125 | WI | N | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.