Healthcare Provider Details

I. General information

NPI: 1306579453
Provider Name (Legal Business Name): KAYLIE MAE WILLPRECHT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KAYLIE MAE SCHRAM

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 1ST ST W
BEMIDJI MN
56601-4002
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW STE 110
NEW BRIGHTON MN
55112-1789
US

V. Phone/Fax

Practice location:
  • Phone: 218-888-8032
  • Fax: 218-888-8033
Mailing address:
  • Phone: 651-628-9566
  • Fax: 651-628-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: