Individual
MRS. KIM MARIE AUSSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.O.T.A.
Contact information
Practice address
3100 WASHIHGTON ROAD, WASHINGTON MANOR, KENOSHA, WI 53144
(262) 658-4039
Mailing address
3100 WASHIHGTON ROAD, WASHINGTON MANOR, KENOSHA, WI 53144
(262) 658-4039
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1138-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40867200
—
WI
Enumeration date
05/05/2008
Last updated
05/05/2008
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