Provider Demographics
NPI:1588904726
Name:PAGE STONE, KIMBERLY ANN (MS PC IT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:PAGE STONE
Suffix:
Gender:F
Credentials:MS PC IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 MOSSY OAK CIR
Mailing Address - Street 2:APARTMENT 92
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-7129
Mailing Address - Country:US
Mailing Address - Phone:920-883-9422
Mailing Address - Fax:
Practice Address - Street 1:2970 MOSSY OAK CIR
Practice Address - Street 2:APARTMENT 92
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-7129
Practice Address - Country:US
Practice Address - Phone:920-883-9422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7020-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health