1821611591 NPI number — SATIA KAVANAUGH VANDERLOOP MS, CRC, LPC, CSAC

NPI Number: 1821611591
Health Care Provider/Practitioner: SATIA KAVANAUGH VANDERLOOP MS, CRC, LPC, CSAC

NPI Number : 1821611591 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1821611591",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KAVANAUGH VANDERLOOP",
    "FirstName": "SATIA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, CRC, LPC, CSAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1204 HOOVER AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LITTLE CHUTE",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54140-2308",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "920-419-5771",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2194 EASTRIDGE CTR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EAU CLAIRE",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54701-3403",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "715-598-1568",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/28/2020",
    "LastUpdateDate": "09/17/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "8552-125",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "17122-132",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}