Katie J Prucha, LPC-IT
Individual provider Active NPI Professional Counselor · Brookfield, WI
NPI 1871018010 · NPPES record last updated Aug 9, 2017
Key facts
- NPI
- 1871018010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 3620-226 (WI)
- Practice address
- 16535 W Bluemound Rd Ste 305
Brookfield, WI 53005-5936 - Phone
- (800) 438-1772
- Fax
- (262) 293-9737
- NPI assigned
- Aug 9, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3620-226 | WI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wisconsin Lutheran Child and Family Service Inc | Professional | Past | Accepting new patients |
| Wisconsin Lutheran Child & Family Services, Inc | Professional | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 3620-226 | WI | Yes |
Addresses
Primary practice location
16535 W Bluemound Rd Ste 305
Brookfield, WI 53005-5936
Mailing address
W175N11120 Stonewood Dr
Germantown, WI 53022-6511
Phone (800) 438-1772
Other names
- Katie J Peterson
Other providers in Brookfield, WI
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- Providence Psychiatric Services S C
- Sharayah K Provost
- Sherry L Prowatzke
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- Psychological Health Services LLC
- Melissa Ptacek
All providers in Brookfield, WI · Professional Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.