Healthcare Provider Details

I. General information

NPI: 1063155307
Provider Name (Legal Business Name): KRISTINA WILLMERING LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA BOTEVA

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16535 W BLUEMOUND RD STE 200
BROOKFIELD WI
53005-5906
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 262-542-3255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11690125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: