Provider Demographics
NPI:1710212394
Name:HEMAUER, KRISTINE (MA, LSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:HEMAUER
Suffix:
Gender:F
Credentials:MA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 ENLOE ST.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016
Mailing Address - Country:US
Mailing Address - Phone:715-377-0000
Mailing Address - Fax:715-377-0010
Practice Address - Street 1:2910 ENLOE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-4538
Practice Address - Country:US
Practice Address - Phone:715-377-0000
Practice Address - Fax:715-377-0010
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1376659201103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty