Provider Demographics
NPI:1063889996
Name:KEEFE-NEILSON, KATHRYN EILEEN (MS ED, LPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:EILEEN
Last Name:KEEFE-NEILSON
Suffix:
Gender:F
Credentials:MS ED, LPC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:EILEEN
Other - Last Name:KEEFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22308
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2308
Mailing Address - Country:US
Mailing Address - Phone:920-436-4360
Mailing Address - Fax:920-432-5966
Practice Address - Street 1:1810 APPLETON RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1110
Practice Address - Country:US
Practice Address - Phone:920-739-4226
Practice Address - Fax:920-739-7639
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2627-226101YM0800X
WI6776101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health