Provider Demographics
NPI:1205207180
Name:KOLF, CHERYL LYNN (MS-MHC, MED, LPC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:KOLF
Suffix:
Gender:F
Credentials:MS-MHC, MED, LPC
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:KELLER KOLF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSMHC, MED LPC
Mailing Address - Street 1:220 WISCONSIN DELLS PKWY S STE 1
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965-8328
Mailing Address - Country:US
Mailing Address - Phone:608-448-6418
Mailing Address - Fax:844-705-0151
Practice Address - Street 1:220 WISCONSIN DELLS PKWY S STE 1
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-8328
Practice Address - Country:US
Practice Address - Phone:608-448-6418
Practice Address - Fax:844-705-0151
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2732-226101YM0800X
WI7066125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI56175Medicaid