Provider Demographics
NPI:1619023090
Name:ZIRKEL, KIP H (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIP
Middle Name:H
Last Name:ZIRKEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:CLIFFORD
Other - Middle Name:HERBERT
Other - Last Name:ZIRKEL
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1707 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4200
Mailing Address - Country:US
Mailing Address - Phone:608-785-0001
Mailing Address - Fax:608-785-0002
Practice Address - Street 1:1707 MAIN ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4200
Practice Address - Country:US
Practice Address - Phone:608-785-0001
Practice Address - Fax:608-785-0002
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI781103TC2200X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39018600Medicaid
HP69927OtherHEALTHPARTNERS
MN13G9521OtherBCBS-MN
WI31097OtherNAT. REGIS. OF H.C. PROV.
MN852578100Medicaid
HP69927OtherHEALTHPARTNERS
WI31097OtherNAT. REGIS. OF H.C. PROV.