Provider Demographics
NPI:1639758352
Name:LOVELAND, KIMBERLY RAE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RAE
Last Name:LOVELAND
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 1:8620 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:ROSHOLT
Mailing Address - State:WI
Mailing Address - Zip Code:54473-9534
Mailing Address - Country:US
Mailing Address - Phone:920-713-6017
Mailing Address - Fax:
Practice Address - Street 1:2558 POST RD
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-3331
Practice Address - Country:US
Practice Address - Phone:715-600-2798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical