Healthcare Provider Details

I. General information

NPI: 1609156488
Provider Name (Legal Business Name): KRISTEN ANN WLODEK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W CAPITOL DR
MILWAUKEE WI
53212-1123
US

IV. Provider business mailing address

210 W CAPITOL DR
MILWAUKEE WI
53212-1123
US

V. Phone/Fax

Practice location:
  • Phone: 414-727-6320
  • Fax: 414-727-6321
Mailing address:
  • Phone: 414-727-6320
  • Fax: 414-727-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3948
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6107-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: