=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871186262
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY HOOVER LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2021
-----------------------------------------------------
Last Update Date | 05/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 165 W NETHERWOOD ST
-----------------------------------------------------
City | OREGON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53575-1107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-835-5050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1033 LEWELLEN ST
-----------------------------------------------------
City | MARSHALL
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53559-9003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-316-5853
-----------------------------------------------------
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------