Provider Demographics
NPI:1982100400
Name:BUNE, KRISTINE NICHOLE (MS, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:NICHOLE
Last Name:BUNE
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:MISS
Other - First Name:KRISTINE
Other - Middle Name:NICHOLE
Other - Last Name:BUNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC, NCC
Mailing Address - Street 1:620 S 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-1599
Mailing Address - Country:US
Mailing Address - Phone:414-453-1400
Mailing Address - Fax:414-453-2538
Practice Address - Street 1:620 S 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-1599
Practice Address - Country:US
Practice Address - Phone:414-453-1400
Practice Address - Fax:414-453-2538
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5980-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1982100400Medicaid