Provider Demographics
NPI:1902002371
Name:WICHMAN, KRISTAL KAY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:KAY
Last Name:WICHMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 W LAWRENCE ST # 105
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5834
Mailing Address - Country:US
Mailing Address - Phone:920-277-9085
Mailing Address - Fax:
Practice Address - Street 1:621 W LAWRENCE ST # 105
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5834
Practice Address - Country:US
Practice Address - Phone:920-277-9085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7923-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical