Healthcare Provider Details

I. General information

NPI: 1396943130
Provider Name (Legal Business Name): KIMBERLY A. HLAVKA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 S COMMERCIAL ST
NEENAH WI
54956-6152
US

IV. Provider business mailing address

1509 S COMMERCIAL ST
NEENAH WI
54956-6152
US

V. Phone/Fax

Practice location:
  • Phone: 920-722-8150
  • Fax: 920-722-0142
Mailing address:
  • Phone: 920-722-8150
  • Fax: 920-722-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3391-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: