Provider Demographics
NPI:1235828534
Name:SOTALA, CORRIN (LPC-IT)
Entity Type:Individual
Prefix:MS
First Name:CORRIN
Middle Name:
Last Name:SOTALA
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5141
Mailing Address - Country:US
Mailing Address - Phone:262-804-7066
Mailing Address - Fax:
Practice Address - Street 1:1930 MELODY LN
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5141
Practice Address - Country:US
Practice Address - Phone:262-804-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7235226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional