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General NPI Number Information
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NPI Number | 1972942175
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Entity Type | Individual
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Provider Name | KIMBERLY LEWIS LCSW, CSAC
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Gender | Female
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Dates
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Enumeration Date | 06/20/2013
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 140 W MAIN ST STE E
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City | WINNECONNE
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State | WI
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Zip | 54986-9409
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Country | US
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Telephone | 920-460-9814
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 S. KENSINGTON DR. STE. 400
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City | APPLETON
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State | WI
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Zip | 54915-4186
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Country | US
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Telephone | 920-659-0634
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Fax | 920-239-6003
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 14548-132
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7377-123
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7377
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7377-123
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License Number State | WI
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