Healthcare Provider Details

I. General information

NPI: 1134805443
Provider Name (Legal Business Name): KRISTIN ENSMINGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN SCHELL LCSW

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 SIMON CRESTWAY
WAUNAKEE WI
53597-1731
US

IV. Provider business mailing address

116 SIMON CRESTWAY
WAUNAKEE WI
53597-1731
US

V. Phone/Fax

Practice location:
  • Phone: 303-880-6392
  • Fax:
Mailing address:
  • Phone: 303-880-6392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8495-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00992696
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: