Basic Information
| Provider Information | |||||||||
| NPI: | 1689921785 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEARNS | ||||||||
| FirstName: | ABIGAIL | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ST. LOUIS | ||||||||
| OtherFirstName: | ABIGAIL | ||||||||
| OtherMiddleName: | E.J. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 625 W WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537032637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082802700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 625 W WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537032637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082802700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2012 | ||||||||
| LastUpdateDate: | 08/07/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 7780-123 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.