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General NPI Number Information
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NPI Number | 1689195653
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Entity Type | Individual
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Provider Name | KAITLYN MARIE VILLALPANDO LPC
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Gender | Female
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Dates
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Enumeration Date | 06/29/2017
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 575 4TH ST
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City | KEWAUNEE
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State | WI
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Zip | 54216-1785
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Country | US
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Telephone | 920-388-4640
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Fax | 920-338-0479
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Provider Business Mailing Address
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Address Line | 744 S WEBSTER AVE MEDICAL STAFF SERVICES
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City | GREEN BAY
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State | WI
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Zip | 54301-3505
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3573-226
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7465-125
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License Number State | WI
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