Healthcare Provider Details

I. General information

NPI: 1629930185
Provider Name (Legal Business Name): SIMONE A NINHAM MSW, APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2640 W POINT RD
GREEN BAY WI
54304-1344
US

IV. Provider business mailing address

PO BOX 365
ONEIDA WI
54155-0365
US

V. Phone/Fax

Practice location:
  • Phone: 920-490-3790
  • Fax: 920-490-3858
Mailing address:
  • Phone: 920-869-2711
  • Fax: 920-869-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number132249
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: