Provider Demographics
NPI:1538943832
Name:MCRAE, KATHY L
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:MCRAE
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 1:4957 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5618
Mailing Address - Country:US
Mailing Address - Phone:414-793-5899
Mailing Address - Fax:414-509-5370
Practice Address - Street 1:4957 N 25TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5618
Practice Address - Country:US
Practice Address - Phone:414-229-8719
Practice Address - Fax:414-509-5370
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI001025863747P1801X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant