Provider Demographics
NPI:1811049422
Name:KIRCHNER, ANN ELIZABETH (LCSW LPC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ELIZABETH
Last Name:KIRCHNER
Suffix:
Gender:F
Credentials:LCSW LPC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:ELIZABETH
Other - Last Name:LEMAHIEU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1810 APPLETON ROAD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952
Mailing Address - Country:US
Mailing Address - Phone:920-739-4226
Mailing Address - Fax:920-739-7639
Practice Address - Street 1:1810 APPLETON ROAD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952
Practice Address - Country:US
Practice Address - Phone:920-739-4226
Practice Address - Fax:920-739-7639
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1221 125101YP2500X
WI2259 1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39629900Medicaid