Woody, Kathleen Broderick

Woody, Kathleen Broderick is an individual health care provider with primary practice located at 2645 N Mayfair Rd Suite 130, Wauwatosa WI 53226-1304. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavioral Analyst, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Woody, Kathleen Broderick can be contacted via phone (414) 256-0077.

Contact Information

Primary practice address
2645 N Mayfair Rd Suite 130 Wauwatosa WI 53226-1304
Phone: (414) 256-0077
Fax: (414) 256-0090
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 181-140 Wisconsin
Behavioral Health & Social Service Providers / Clinical 103TC0700X 2041-057 Wisconsin

Profile Details

NPI number 1568525673
LBN Legal business name Woody, Kathleen Broderick
Credentials PSY.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 19th, 2006
Last updated Jul 14th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568525673 NPPES
Wisconsin MEDICAID 39707200

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