Provider Demographics
NPI:1275881203
Name:GENSKE, KIMBERLY J
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:GENSKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10734 OTTO RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:WI
Mailing Address - Zip Code:54406-9330
Mailing Address - Country:US
Mailing Address - Phone:715-252-3376
Mailing Address - Fax:
Practice Address - Street 1:10734 OTTO RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:WI
Practice Address - Zip Code:54406-9330
Practice Address - Country:US
Practice Address - Phone:715-252-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical