Provider Demographics
NPI:1760009823
Name:ZIEMBA, KAYLA E (APSW)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:E
Last Name:ZIEMBA
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:E
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APSW
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-0309
Mailing Address - Country:US
Mailing Address - Phone:715-349-7069
Mailing Address - Fax:888-625-8634
Practice Address - Street 1:442 N WESTHILL BLVD
Practice Address - Street 2:STE B
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-5830
Practice Address - Country:US
Practice Address - Phone:920-364-9668
Practice Address - Fax:888-625-8634
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131743-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1760009823Medicaid