Provider Demographics
NPI:1154438562
Name:MOSTER, KIMBERLEE M (LPC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:M
Last Name:MOSTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 WASHINGTON AVE STE 3C
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3992
Mailing Address - Country:US
Mailing Address - Phone:262-456-3712
Mailing Address - Fax:262-672-4147
Practice Address - Street 1:6214 WASHINGTON AVE STE 3C
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3992
Practice Address - Country:US
Practice Address - Phone:262-456-3712
Practice Address - Fax:262-672-4147
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2816-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39735200Medicaid