Provider Demographics
NPI:1245287457
Name:BUCHANAN KRUPICKA, KIMBERLY (LCSW CADC III)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BUCHANAN KRUPICKA
Suffix:
Gender:F
Credentials:LCSW CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0002
Mailing Address - Country:US
Mailing Address - Phone:608-785-0940
Mailing Address - Fax:
Practice Address - Street 1:310 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-2142
Practice Address - Country:US
Practice Address - Phone:608-269-4132
Practice Address - Fax:608-269-1017
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2241101YA0400X
WI42281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39385000Medicaid