Provider Demographics
NPI:1437927910
Name:STITELEY, KATHLEEN (MA, LPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:STITELEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 BAETEN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4869
Mailing Address - Country:US
Mailing Address - Phone:920-445-9723
Mailing Address - Fax:
Practice Address - Street 1:677 BAETEN RD STE 201
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4869
Practice Address - Country:US
Practice Address - Phone:920-445-9723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11610-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional