MEDICARE: MRS. KIMBERLY ANN PAGE STONE MS PC IT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	7020-125	WI

General Provider Information

NPI Number	:	1588904726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY ANN PAGE STONE MS PC IT

Provider Business Mailing Address
First Line	:	2970 MOSSY OAK CIR
Second Line	:	APARTMENT 92
City	:	GREEN BAY
State	:	WI
Zip	:	54311-7129
Country	:	US
Telephone Number	:	920-883-9422
Fax Number	:

Provider Business Practice Location Address
First Line	:	2970 MOSSY OAK CIR
Second Line	:	APARTMENT 92
City	:	GREEN BAY
State	:	WI
Zip	:	54311-7129
Country	:	US
Telephone Number	:	920-883-9422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	09/25/2024

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