Provider Demographics
NPI:1871084012
Name:WASHINGTON, KIMBERLY HEATHER (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:HEATHER
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 S ROCHESTER ST STE 260A
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9031
Mailing Address - Country:US
Mailing Address - Phone:262-374-4150
Mailing Address - Fax:
Practice Address - Street 1:1231 S ROCHESTER ST STE 260A
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9031
Practice Address - Country:US
Practice Address - Phone:262-374-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7606-125101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health