Basic Information
| Provider Information | |||||||||
| NPI: | 1992365886 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHWAFFEL | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SCHWALBE | ||||||||
| OtherFirstName: | KATIE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 208 E OLIN AVE STE 205 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537131434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082803150 | ||||||||
| FaxNumber: | 6082372690 | ||||||||
| Practice Location | |||||||||
| Address1: | 3821 NAKOMA RD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537113015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202792088 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2019 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 11950-120 | WI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.