Provider Demographics
NPI:1306283742
Name:FENNIE, KARLA MATHEWS (MS, MFT)
Entity type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:MATHEWS
Last Name:FENNIE
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 5TH AVE S
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601
Mailing Address - Country:US
Mailing Address - Phone:608-797-4741
Mailing Address - Fax:
Practice Address - Street 1:115 5TH AVE S
Practice Address - Street 2:SUITE 301
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-797-4741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI347-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist