Individual
LACEY KIMPEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1737 ERIN LN, WAUKESHA, WI 53188-4800
(262) 613-9478
Mailing address
1737 ERIN LN, WAUKESHA, WI 53188-4800
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
130311-121
WI
1041C0700X
Clinical Social Worker
130311-121
WI
1041C0700X
Clinical Social Worker
Primary
9776-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285010009
—
WI
Enumeration date
08/04/2015
Last updated
10/09/2021
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