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Provider Information for 1174937882


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REBECCA M KINNUNEN APSW


Sex: Female

NPI: 1174937882
Last Updated: 2014-06-20
Certification Date:

Details

NameValue
NPI1174937882
Enumeration Date2014-06-20
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 721 AMERICAN AVE
SUITE 501
WAUKESHA, WI 53188-5071
United States

Phone: 262-928-4036 | Fax:262-928-5096
 
Primary Practice Address 721 AMERICAN AVE
SUITE 501
WAUKESHA, WI 53188-5071
United States

Phone: 262-928-4036 | Fax:262-928-5096
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)WI127679-121Wisconsin APSW license
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 104100000X - Social Worker