Healthcare Provider Details

I. General information

NPI: 1669454088
Provider Name (Legal Business Name): KIMBERLY R. SKERVEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2005
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N SUNNY SLOPE RD STE. 128
BROOKFIELD WI
53005-4809
US

IV. Provider business mailing address

7720 W EDEN PL
MILWAUKEE WI
53220-1148
US

V. Phone/Fax

Practice location:
  • Phone: 262-782-2820
  • Fax:
Mailing address:
  • Phone: 414-374-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2800
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6989-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: