Provider Demographics
NPI:1255013264
Name:WITZIG, KATHY JO (LPC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:JO
Last Name:WITZIG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14884 BREEZY HILL RD
Mailing Address - Street 2:
Mailing Address - City:FENNIMORE
Mailing Address - State:WI
Mailing Address - Zip Code:53809-9745
Mailing Address - Country:US
Mailing Address - Phone:608-732-4855
Mailing Address - Fax:
Practice Address - Street 1:8215 GREENWAY BLVD STE 160
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3689
Practice Address - Country:US
Practice Address - Phone:608-236-4460
Practice Address - Fax:608-236-4461
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1398-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional