Healthcare Provider Details

I. General information

NPI: 1417167586
Provider Name (Legal Business Name): ELIZABETH ANN HUNKINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 CONSERVANCY DR
JOHNSON CREEK WI
53038-8700
US

IV. Provider business mailing address

429 CONSERVANCY DR
JOHNSON CREEK WI
53038-8700
US

V. Phone/Fax

Practice location:
  • Phone: 920-342-4105
  • Fax:
Mailing address:
  • Phone: 920-342-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7249-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: