Healthcare Provider Details

I. General information

NPI: 1750760534
Provider Name (Legal Business Name): KIMBERLY HEINE MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MADISON AVE
FORT ATKINSON WI
53538-1444
US

IV. Provider business mailing address

511 MADISON AVE
FORT ATKINSON WI
53538-1444
US

V. Phone/Fax

Practice location:
  • Phone: 920-541-3078
  • Fax:
Mailing address:
  • Phone: 920-541-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16938-130
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1471-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: