Provider Demographics
NPI:1255492799
Name:CORONA-LONDRE, KAREN LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LEE
Last Name:CORONA-LONDRE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:LEE
Other - Last Name:LONDRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2515 SMITH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601
Mailing Address - Country:US
Mailing Address - Phone:608-769-6619
Mailing Address - Fax:608-788-1974
Practice Address - Street 1:2515 SMITH VALLEY RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-769-6619
Practice Address - Fax:608-788-1974
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2328057103TC0700X
WI2328-57103TC0700X
MNLP5638103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39133600Medicaid
WI2328057OtherWISCONSIN STATE LICENSE