MEDICARE: DEBORAH LEWIS VANDERKINTER LPC, SAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	16396-131	WI
2	101YM0800X	Mental Health Counselor	7596-125	WI

General Provider Information

NPI Number	:	1528690427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH LEWIS VANDERKINTER LPC, SAC

Provider Business Mailing Address
First Line	:	N170W20265 HUNTERS RD
Second Line	:
City	:	JACKSON
State	:	WI
Zip	:	53037-9422
Country	:	US
Telephone Number	:	920-360-9619
Fax Number	:

Provider Business Practice Location Address
First Line	:	1519 E WASHINGTON ST STE A
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-2615
Country	:	US
Telephone Number	:	262-346-4700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2020
Last Update Date	:	09/12/2023

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