Provider Demographics
NPI:1851009898
Name:HOWARD, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HOWARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5464 N PORT WASHINGTON RD STE C103
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4925
Mailing Address - Country:US
Mailing Address - Phone:414-301-3145
Mailing Address - Fax:
Practice Address - Street 1:6650 W STATE ST UNIT D143
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2827
Practice Address - Country:US
Practice Address - Phone:414-301-3145
Practice Address - Fax:414-296-0093
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130835104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker