Provider Demographics
NPI:1922349935
Name:KIEKHOEFER, REBECCA JOAN
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOAN
Last Name:KIEKHOEFER
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 1:416 S LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:HOWARDS GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53083-1243
Mailing Address - Country:US
Mailing Address - Phone:715-456-6114
Mailing Address - Fax:
Practice Address - Street 1:416 S LINCOLN DR
Practice Address - Street 2:
Practice Address - City:HOWARDS GROVE
Practice Address - State:WI
Practice Address - Zip Code:53083-1243
Practice Address - Country:US
Practice Address - Phone:715-456-6114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist