Healthcare Provider Details

I. General information

NPI: 1952395477
Provider Name (Legal Business Name): KIM A STEEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 1/2 W GENEVA ST
ELKHORN WI
53121-1722
US

IV. Provider business mailing address

1 1/2 W GENEVA ST
ELKHORN WI
53121-1722
US

V. Phone/Fax

Practice location:
  • Phone: 262-723-3424
  • Fax:
Mailing address:
  • Phone: 262-723-3424
  • Fax: 262-723-8308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2143123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: