1750743365 NPI number — MRS. KIMBERLY MARIE KRAEGER LCSW

Table of content: MRS. KIMBERLY MARIE KRAEGER LCSW (NPI 1750743365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750743365 NPI number — MRS. KIMBERLY MARIE KRAEGER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRAEGER
Provider First Name:
KIMBERLY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750743365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WAUPACA COUNTY DHHS
Provider Second Line Business Mailing Address:
811 HARDING ST.
Provider Business Mailing Address City Name:
WAUPACA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-258-6305
Provider Business Mailing Address Fax Number:
715-258-6409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WAUPACA COUNTY DHHS
Provider Second Line Business Practice Location Address:
811 HARDING ST
Provider Business Practice Location Address City Name:
WAUPACA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-258-6305
Provider Business Practice Location Address Fax Number:
715-258-6409
Provider Enumeration Date:
03/23/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  129467-121 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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