Healthcare Provider Details

I. General information

NPI: 1447651203
Provider Name (Legal Business Name): KELLY JEAN HOPPE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/24/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W WASHINGTON AVE STE 630
MADISON WI
53703-2758
US

IV. Provider business mailing address

122 W WASHINGTON AVE STE 630
MADISON WI
53703-2758
US

V. Phone/Fax

Practice location:
  • Phone: 855-226-7215
  • Fax: 608-236-4461
Mailing address:
  • Phone: 855-226-7215
  • Fax: 608-236-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6325-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: