Provider Demographics
NPI:1194800490
Name:CRANDELL, CATHY J (PHD)
Entity type:Individual
Prefix:DR
First Name:CATHY
Middle Name:J
Last Name:CRANDELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 N FARWELL AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2904
Mailing Address - Country:US
Mailing Address - Phone:414-271-5577
Mailing Address - Fax:414-271-6667
Practice Address - Street 1:1428 N FARWELL AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2904
Practice Address - Country:US
Practice Address - Phone:414-271-5577
Practice Address - Fax:414-271-6667
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI878-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39023600Medicaid
WI39023600Medicaid