Provider Demographics
NPI:1992534515
Name:KMECHECK, KRISTIN MARIE (APSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:KMECHECK
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 E NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-3938
Mailing Address - Country:US
Mailing Address - Phone:920-659-6121
Mailing Address - Fax:920-267-3480
Practice Address - Street 1:502 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-3938
Practice Address - Country:US
Practice Address - Phone:920-659-6121
Practice Address - Fax:920-267-3480
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1350291211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical