Provider Demographics
NPI:1376314500
Name:HAVEL, KRISTIN JOY
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JOY
Last Name:HAVEL
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 1:511 E HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-1813
Mailing Address - Country:US
Mailing Address - Phone:906-280-2728
Mailing Address - Fax:
Practice Address - Street 1:2935 UNIVERSAL CT STE 2
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-6324
Practice Address - Country:US
Practice Address - Phone:920-718-7223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional