Provider Demographics
NPI:1699521252
Name:KIRCHBERG, REBECCA J (CPM LM)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:KIRCHBERG
Suffix:
Gender:F
Credentials:CPM LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4731 US HIGHWAY 151
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-9449
Mailing Address - Country:US
Mailing Address - Phone:920-382-0642
Mailing Address - Fax:262-290-4883
Practice Address - Street 1:W6479 E PINE ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:WI
Practice Address - Zip Code:53926-7100
Practice Address - Country:US
Practice Address - Phone:608-369-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
WIWI49-316176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula