Provider Demographics
NPI:1750743365
Name:KRAEGER, KIMBERLY MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:KRAEGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WAUPACA COUNTY DHHS
Mailing Address - Street 2:811 HARDING ST.
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981
Mailing Address - Country:US
Mailing Address - Phone:715-258-6305
Mailing Address - Fax:715-258-6409
Practice Address - Street 1:WAUPACA COUNTY DHHS
Practice Address - Street 2:811 HARDING ST
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981
Practice Address - Country:US
Practice Address - Phone:715-258-6305
Practice Address - Fax:715-258-6409
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129467-121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional