Healthcare Provider Details

I. General information

NPI: 1598379935
Provider Name (Legal Business Name): KRISTIN ANN HOOPER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 07/14/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W6144 AEROTECH DR
APPLETON WI
54914-7503
US

IV. Provider business mailing address

2721 COMMONWEALTH CT
APPLETON WI
54914-6440
US

V. Phone/Fax

Practice location:
  • Phone: 920-733-2065
  • Fax:
Mailing address:
  • Phone: 920-540-7383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4310
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8128
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: