Provider Demographics
NPI:1639473622
Name:HUENINK, KRISTINE CAROL
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:CAROL
Last Name:HUENINK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N 5TH ST STE 8
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4623
Mailing Address - Country:US
Mailing Address - Phone:920-838-1481
Mailing Address - Fax:888-700-4809
Practice Address - Street 1:601 N 5TH ST STE 8
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4623
Practice Address - Country:US
Practice Address - Phone:920-838-1481
Practice Address - Fax:888-700-4809
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15562-130101YA0400X
WI4467-125101YP2500X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional