Basic Information
Provider Information
NPI: 1508971300
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KUNKEL
FirstName: ALLISON
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: MS APSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 20361 COUNTY HWY S
Address2:  
City: JIM FALLS
State: WI
PostalCode: 547481824
CountryCode: US
TelephoneNumber: 7153824710
FaxNumber:  
Practice Location
Address1: 2004 HIGHLAND AVE
Address2: SUITE N
City: EAU CLAIRE
State: WI
PostalCode: 547014400
CountryCode: US
TelephoneNumber: 7158355915
FaxNumber: 7158358112
Other Information
ProviderEnumerationDate: 08/20/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X1071-121WIY Behavioral Health & Social Service ProvidersSocial Worker 

ID Information
IDTypeStateIssuerDescription
4357890005WI MEDICAID


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