| Doctor Name: | KATHLEEN M BULLARD |
| NPI Number: | 1033550934 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, LPC-IT, SAC-IT |
| License Number: | 1680-130 |
| Business Practice Address: | 3900 W Brown Deer Rd Ste 200 Brown Deer, WI - 532091220 |
| Business Phone Number: | 4145402170 |
| Business Fax Number: | 4145402171 |
| Mailing Address: | 3900 W Brown Deer Rd Ste 200, BROWN DEER |
| State: | WI |
| Postal Code: | 532091220 |
| Phone Number: | 4145402170 |
| Fax Number: | 4145402171 |
| NPI Enumeration Date: | 07/09/2013 |
| NPI Last Update Date: | 07/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1680-130 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |