Provider Demographics
NPI:1669454088
Name:SKERVEN, KIMBERLY R (PHD)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:R
Last Name:SKERVEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 W EDEN PL
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-1148
Mailing Address - Country:US
Mailing Address - Phone:414-374-8188
Mailing Address - Fax:
Practice Address - Street 1:250 N SUNNY SLOPE RD
Practice Address - Street 2:STE. 128
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4809
Practice Address - Country:US
Practice Address - Phone:262-782-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-20
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6989-1231041C0700X
WI2800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43572600Medicaid
WI43572600Medicaid