Healthcare Provider Details

I. General information

NPI: 1720415631
Provider Name (Legal Business Name): CAROL KUHLOW MS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 E CAPITOL DR # 400
SHOREWOOD WI
53211-2119
US

IV. Provider business mailing address

W 4580 COUNTY ROAD IW
WALDO WI
53093
US

V. Phone/Fax

Practice location:
  • Phone: 920-564-2625
  • Fax:
Mailing address:
  • Phone: 920-564-2625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4488-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: