Provider Demographics
NPI:1982946364
Name:POPE, KATHRYN J (LCSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:POPE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:POPE
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1314 S 1ST ST # 135
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-2405
Mailing Address - Country:US
Mailing Address - Phone:312-757-0300
Mailing Address - Fax:
Practice Address - Street 1:2025 N SUMMIT AVE STE 111
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1362
Practice Address - Country:US
Practice Address - Phone:312-757-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-23
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-063421041C0700X
IL149.0210421041C0700X
WI11254-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM45983542Medicaid