Healthcare Provider Details

I. General information

NPI: 1437847548
Provider Name (Legal Business Name): KRISTEL LYN HAWLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 REDBIRD CIR
DE PERE WI
54115-7977
US

IV. Provider business mailing address

PO BOX 22040
GREEN BAY WI
54305-2040
US

V. Phone/Fax

Practice location:
  • Phone: 920-338-6830
  • Fax: 920-338-6879
Mailing address:
  • Phone: 920-445-7210
  • Fax: 920-445-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10120-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: