Provider Demographics
NPI:1255584066
Name:YODER, KATHLEEN (LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:YODER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 MILWAUKEE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1230
Mailing Address - Country:US
Mailing Address - Phone:262-767-0440
Mailing Address - Fax:262-767-0777
Practice Address - Street 1:441 MILWAUKEE AVE STE 2
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1230
Practice Address - Country:US
Practice Address - Phone:262-767-0440
Practice Address - Fax:262-767-0777
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6930-123101YM0800X
IL149.005616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health