Provider Demographics
NPI:1003394420
Name:WELLE, VIRGINIA KAY (MS, LPC-IT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:KAY
Last Name:WELLE
Suffix:
Gender:F
Credentials:MS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22872 COUNTY HIGHWAY Q
Mailing Address - Street 2:
Mailing Address - City:NEW AUBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54757-5414
Mailing Address - Country:US
Mailing Address - Phone:715-933-0800
Mailing Address - Fax:
Practice Address - Street 1:509 E SOUTH AVE
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3402
Practice Address - Country:US
Practice Address - Phone:715-861-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4021-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional