Healthcare Provider Details

I. General information

NPI: 1174969976
Provider Name (Legal Business Name): KIM MERLE TRUDELL LCSW, SAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIM M WITKOWSKI MSW

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 W COLLEGE AVE
APPLETON WI
54914-5290
US

IV. Provider business mailing address

2153 COUNTRY LN
NEENAH WI
54956-1000
US

V. Phone/Fax

Practice location:
  • Phone: 920-239-4400
  • Fax: 920-532-1052
Mailing address:
  • Phone: 608-513-3769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: