Provider Demographics
NPI:1457872384
Name:ZACHER, KIMBERLY ANN (MS, LPC, SAC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:ZACHER
Suffix:
Gender:
Credentials:MS, LPC, SAC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:KOUDELKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17160 W NORTH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4437
Mailing Address - Country:US
Mailing Address - Phone:414-640-9574
Mailing Address - Fax:
Practice Address - Street 1:17160 W NORTH AVE STE 201
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4437
Practice Address - Country:US
Practice Address - Phone:414-640-9574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7466-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional