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General NPI Number Information
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NPI Number | 1164918702
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Entity Type | Individual
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Provider Name | OLIVIA MARIE KEMPEMA MS-MFT
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Gender | Female
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 201 PARK ST
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City | FORT ATKINSON
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State | WI
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Zip | 53538-2155
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Country | US
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Telephone | 920-563-9542
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Fax |
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Provider Business Mailing Address
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Address Line | 500 MCMILLEN ST
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City | FORT ATKINSON
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State | WI
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Zip | 53538-1233
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 538228
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1251124
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License Number State | WI
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