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General NPI Number Information
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NPI Number | 1376314914
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Entity Type | Individual
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Provider Name | KAREN THERESE VANDERVORT LPC-IT
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Gender | Female
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Dates
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Enumeration Date | 01/11/2024
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | N91W17194 APPLETON AVE STE 204
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-2083
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Country | US
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Telephone | 414-502-7780
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Fax |
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Provider Business Mailing Address
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Address Line | 3505 S RIVER GLEN LN APT 2
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City | GREENFIELD
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State | WI
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Zip | 53228-1186
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Country | US
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Telephone | 309-830-9524
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C.2304840-TRNE
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 8115-226
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License Number State | WI
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