Provider Demographics
NPI:1629241153
Name:KUNZ, KIMBERLY ANN (LPC, CSAC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:KUNZ
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 COUNTY RD DF
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:WI
Mailing Address - Zip Code:53039
Mailing Address - Country:US
Mailing Address - Phone:920-386-4094
Mailing Address - Fax:920-386-3812
Practice Address - Street 1:199 COUNTY RD DF
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039
Practice Address - Country:US
Practice Address - Phone:920-386-4094
Practice Address - Fax:920-386-3812
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15286-132101YA0400X
WI3769-125101YM0800X
WI3769101YM0800X
WI15286101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39170500Medicaid