Individual
KIM HANNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
405 E FOREST ST, OCONOMOWOC, WI 53066-3707
(262) 269-1569
Mailing address
N8238 WOODY LN, IXONIA, WI 53036-9551
(262) 719-6038
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
259-226
WI
101YP2500X
Professional Counselor
Primary
4450-125
WI
Other
Enumeration date
10/16/2010
Last updated
10/06/2023
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