Provider Demographics
NPI:1124762174
Name:NETT, KATIE ROSE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ROSE
Last Name:NETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3330 SKY LANE DR
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:WI
Mailing Address - Zip Code:53049-1626
Mailing Address - Country:US
Mailing Address - Phone:920-517-6570
Mailing Address - Fax:
Practice Address - Street 1:2500 OVERLOOK TER
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2254
Practice Address - Country:US
Practice Address - Phone:608-256-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical