| Doctor Name: | DR. RUSSELL WILLIAM KINKADE |
| NPI Number: | 1033295571 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSYD |
| License Number: | 1296 |
| Business Practice Address: | 6214 Washington Avenue Suite C 10 Racine, WI - 53406 |
| Business Phone Number: | 2629895228 |
| Business Fax Number: | |
| Mailing Address: | S55w29307 Holiday Point, WAUKESHA |
| State: | WI |
| Postal Code: | 531899026 |
| Phone Number: | 2629895228 |
| Fax Number: | |
| NPI Enumeration Date: | 10/27/2006 |
| NPI Last Update Date: | 06/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 1296 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |