Provider Demographics
NPI:1588901805
Name:KADONSKY, KATIE M (LPC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:KADONSKY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:M
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:435 N BROADWAY STE E
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-2516
Mailing Address - Country:US
Mailing Address - Phone:920-214-5929
Mailing Address - Fax:844-903-4616
Practice Address - Street 1:435 N BROADWAY STE E
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-2516
Practice Address - Country:US
Practice Address - Phone:920-214-5929
Practice Address - Fax:844-903-4616
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1080-226101YM0800X
WI5373-125101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health