Provider Demographics
NPI:1528330784
Name:KILEY, ELIZABETH K (MS, LPC, CSAC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:KILEY
Suffix:
Gender:F
Credentials:MS, LPC, CSAC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:K
Other - Last Name:GONSTEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC, SAC
Mailing Address - Street 1:25 KESSEL CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6227
Mailing Address - Country:US
Mailing Address - Phone:608-280-2645
Mailing Address - Fax:608-280-2655
Practice Address - Street 1:25 KESSEL CT
Practice Address - Street 2:SUITE 105
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-6227
Practice Address - Country:US
Practice Address - Phone:608-280-2645
Practice Address - Fax:608-280-2655
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16052-132101YA0400X
WI5447-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional