Provider Demographics
NPI:1578554747
Name:FISCHER, KIMBERLEY HOLLANDER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:HOLLANDER
Last Name:FISCHER
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:N49W17324 SHEFFIELD LN
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-6555
Mailing Address - Country:US
Mailing Address - Phone:262-373-0705
Mailing Address - Fax:
Practice Address - Street 1:500 RIVERVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-4809
Practice Address - Country:US
Practice Address - Phone:262-548-7993
Practice Address - Fax:262-970-4791
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6909-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43571000Medicaid
WI000344800Medicare ID - Type Unspecified