=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255484564
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA J KIRK MSE, LPC, CSAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N5389 BUENA VISTA DR
-----------------------------------------------------
City | FOND DU LAC
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54937-7372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-960-7232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N5389 BUENA VISTA DR
-----------------------------------------------------
City | FOND DU LAC
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54937-7372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-960-7232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2934-125
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------