Healthcare Provider Details

I. General information

NPI: 1598007775
Provider Name (Legal Business Name): KIMBERLY JEAN REYNOLDS LCSW, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY REYNOLDS-SOLAR

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 SUNNYDALE CIR
WEST BEND WI
53090-1980
US

IV. Provider business mailing address

1316 SUNNYDALE CIR
WEST BEND WI
53090-1980
US

V. Phone/Fax

Practice location:
  • Phone: 414-322-6263
  • Fax:
Mailing address:
  • Phone: 706-553-1198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007178
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8378
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: