Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 16230 | WI |
N | 101YP2500X | Professional Counselor | 7326 | WI |
NPI | 1003438391 |
---|---|
Provider Name | Mrs. Kimberly Rose Schlomann |
First Address | Big Bend, WI 53103-9563 |
Second Address | Big Bend, WI 53103-9563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2020 |
Last Update Date | 10/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7326 | (05) | WI |