Provider Demographics
NPI:1265722276
Name:SIMMONS, KRISTIE F (CSAC)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:F
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W KINNE ST
Mailing Address - Street 2:PO BOX 670
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011-9230
Mailing Address - Country:US
Mailing Address - Phone:715-273-6770
Mailing Address - Fax:715-273-6862
Practice Address - Street 1:412 W KINNE ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011-9230
Practice Address - Country:US
Practice Address - Phone:715-273-6770
Practice Address - Fax:715-273-6862
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15280-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)