Healthcare Provider Details

I. General information

NPI: 1376314914
Provider Name (Legal Business Name): KAREN VANDERVORT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N91W17194 APPLETON AVE STE 204
MENOMONEE FALLS WI
53051-2083
US

IV. Provider business mailing address

3505 S RIVER GLEN LN APT 2
GREENFIELD WI
53228-1186
US

V. Phone/Fax

Practice location:
  • Phone: 414-502-7780
  • Fax:
Mailing address:
  • Phone: 309-830-9524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12820-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: