| Doctor Name: | MRS. KATHLEEN FENNO MCNULTY |
| NPI Number: | 1023027414 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.C.S.W. |
| License Number: | 7210-123 |
| Business Practice Address: | 1220 Mound Ave Suite 301 Racine, WI - 534043350 |
| Business Phone Number: | 2626333591 |
| Business Fax Number: | 2626332619 |
| Mailing Address: | 1220 Mound Ave, Suite 301 RACINE |
| State: | WI |
| Postal Code: | 534043350 |
| Phone Number: | 2626333591 |
| Fax Number: | 2626332619 |
| NPI Enumeration Date: | 08/05/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 7210-123 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |