=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225914096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KACEY KING MS, MFT-IT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2025
-----------------------------------------------------
Last Update Date | 08/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2217 VINE ST STE 206
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54016-5888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-441-1828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 502 SPRING ST
-----------------------------------------------------
City | RIVER FALLS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54022-2462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-963-8315
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1184-228
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------