KATHLEEN M BULLARD (NPI# 1033550934) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033550934 |
| Entity Type | Individual |
| Full Name | KATHLEEN M BULLARD |
| Credential | MS, LPC-IT, SAC-IT |
| Practice Address |
647 W Main St Ste 900 Lake Geneva WI 53147 |
| Mailing Address |
647 W Main St Ste 900 Lake Geneva WI 53147-1985 |
| Practice Telephone | 2628061467 |
| Practice Fax Number | 2626617702 |
| Mailing Telephone | 2628061467 |
| Mailing Fax Number | 2626617702 |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2019-06-11 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
1680-130 | WI | Behavioral Health & Social Service Providers |
| Y | 101YP2500X |
Counselor Specialization: Professional |
6363-125 | WI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1033550934 | 05 | |
| WI | 1063993038 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3900 W Brown Deer Rd Ste 200, Brown Deer, WI 532091220 | 4145402170 | 4145402171 |
| 4633 Washington Rd, Kenosha, WI 531444220 | 2626527222 |
| Street Address |
647 W MAIN ST STE 900 |
| City | LAKE GENEVA |
| State | WI |
| Zip Code | 53147 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932548583 | Melinda M Pedersen | Counselor | 647 W Main St Ste 900, Lake Geneva, WI 53147-1985 | 2013-06-17 |
| 1578029443 | Bee Happy Therapy, LLC | Clinic/Center | 647 W Main St Ste 900, Lake Geneva, WI 53147-1985 | 2019-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356951206 | Emily Tanis | Physical Therapist | 6722 Wi-50, Lake Geneva, WI 53147 | 2020-08-05 |
| 1588295653 | Baylee M Noe | Occupational Therapy Assistant | Sage Meadow of Lake Geneva 6722 Wi-50, Lake Geneva, WI 53147 | 2020-01-28 |
| 1124539556 | Roxanne Weber | Registered Nurse | 146 E. Geneva Square, Lake Geneva, WI 53147 | 2017-10-12 |
| 1386969400 | Emily Kathleen Wilczak | Surgery | N2950 Wi-67, Lake Geneva, WI 53147 | 2010-03-31 |
| 1538294020 | Dale Alan Miller | Pharmacist | 2950 St. Hwy. 67, Lake Geneva, WI 53147 | 2007-02-23 |
| 1689779902 | Balistreri & Associates Physical Therapy | Physical Therapist | 902 Wells Street, Lake Geneva, WI 53147 | 2006-09-13 |
| 1336157981 | Nestor C Alabarca | Internal Medicine | 146 E Geneva Square, Lake Geneva, WI 53147 | 2006-08-03 |
| 1144259375 | Kim M. Cuculi | Occupational Therapist | 800 Geneva Pkwy N Ste 3, Lake Geneva, WI 53147 | 2006-07-01 |
| 1396253571 | Amar Y. Patel | Family Medicine | 146 E Geneva Sq, Lake Geneva, WI 53147 | 2018-01-22 |
| 1679017925 | Christina L. Clancy | Nurse Practitioner | 146 E Geneva Sq, Lake Geneva, WI 53147 | 2016-12-06 |
| Find all providers in zip 53147 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063993038 | Kathleen Bullard Psychotherapy LLC | Counselor | 647 W Main St, Lake Geneva, WI 53147-1990 | 2018-08-27 |
| 1649760216 | Lakes Counseling Center, LLC | Counselor | N3255 Uranus Rd, Lake Geneva, WI 53147-3125 | 2018-05-18 |
| 1902259807 | Christina Dame | Counselor | 445 Connie Cir, Lake Geneva, WI 53147-2246 | 2016-07-15 |
| 1932548583 | Melinda M Pedersen | Counselor | 647 W Main St Ste 900, Lake Geneva, WI 53147-1985 | 2013-06-17 |
| 1003016627 | Valarie Jo Lura | Counselor | N3251 Queen Rd, Lake Geneva, WI 53147-3330 | 2007-07-22 |
| 1679606529 | Sally Bardin | Counselor | 101 Broad St Ste 201, Lake Geneva, WI 53147-2061 | 2007-03-13 |
| 1619473998 | Ashlie Moelter | Counselor | 101 Broad St Ste 201, Lake Geneva, WI 53147-2061 | 2018-04-04 |
| 1851757850 | Robert John Barnett | Counselor | 101 Broad St, Suite 201, Lake Geneva, WI 53147-2000 | 2016-01-06 |
| 1871725713 | John Edward Noyer | Counselor | 101 Broad St, Lake Geneva, WI 53147-2000 | 2009-08-11 |
| 1619014859 | Barbara Lynn Mehnert | Counselor | 146 E Geneva Square, Lake Geneva, WI 53147 | 2007-01-30 |
| Find all providers in LAKE GENEVA | ||||
| City | LAKE GENEVA |
| Zip Code | 53147 |
Please comment or provide details below to improve the information on KATHLEEN M BULLARD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.