1760900948 NPI number — KARIANNA MARIE KEARNS MA, LMFT

Table of content: KARIANNA MARIE KEARNS MA, LMFT (NPI 1760900948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760900948 NPI number — KARIANNA MARIE KEARNS MA, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEARNS
Provider First Name:
KARIANNA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LMFT
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:
1760900948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 166
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STONE LAKE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54876-0166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-573-7659
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13380 W TREPANIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYWARD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54843-2186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-730-3042
Provider Business Practice Location Address Fax Number:
847-730-3382
Provider Enumeration Date:
09/07/2017

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: 106H00000X , with the licence number:  166001148 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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