1760009823 NPI number — KAYLA E ZIEMBA APSW

Table of content: KAYLA E ZIEMBA APSW (NPI 1760009823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760009823 NPI number — KAYLA E ZIEMBA APSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIEMBA
Provider First Name:
KAYLA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
KAYLA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760009823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIREN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54872-0309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-349-7069
Provider Business Mailing Address Fax Number:
888-625-8634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
442 N WESTHILL BLVD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
APPLETON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54914-5830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-364-9668
Provider Business Practice Location Address Fax Number:
888-625-8634
Provider Enumeration Date:
07/06/2020

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: 104100000X , with the licence number:  131743-121 , 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)

  • Identifier: 1760009823 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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