Provider Demographics
NPI:1245747021
Name:KONETZKE, HANNAH CHRISTINE (CSAC, LPC-IT)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:CHRISTINE
Last Name:KONETZKE
Suffix:
Gender:F
Credentials:CSAC, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 N JAMES ST
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136-1838
Mailing Address - Country:US
Mailing Address - Phone:920-277-9678
Mailing Address - Fax:
Practice Address - Street 1:E7475 RAWHIDE RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-9025
Practice Address - Country:US
Practice Address - Phone:920-982-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16452-132101YA0400X
WI7481-226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)