Provider Demographics
NPI:1528189735
Name:ESTERLINE, KIMBERLY J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:J
Last Name:ESTERLINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 PINE RIDGE BLVD
Mailing Address - Street 2:ASPIRUS WAUSAU HOSPITAL - ACCHS
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:715-847-2000
Mailing Address - Fax:715-847-2932
Practice Address - Street 1:333 PINE RIDGE BLVD
Practice Address - Street 2:ASPIRUS WAUSAU HOSPITAL - ACCHS
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-847-2000
Practice Address - Fax:715-847-2932
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7054-1231041C0700X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI00584315Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER