Provider Demographics
NPI:1730366634
Name:O'BRIEN-SILLMAN, KIMBERLY K (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:O'BRIEN-SILLMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3948 112TH ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-6774
Mailing Address - Country:US
Mailing Address - Phone:715-271-3373
Mailing Address - Fax:
Practice Address - Street 1:3948 112TH ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-6774
Practice Address - Country:US
Practice Address - Phone:715-271-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12024-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI435-80600Medicaid