Provider Demographics
NPI:1255661120
Name:REACHING YOUR POTENTIAL, LLC
Entity Type:Organization
Organization Name:REACHING YOUR POTENTIAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CORONA-LONDRE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD; BCBA-D
Authorized Official - Phone:608-769-6619
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:54601-2941
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:54601-2941
Practice Address - Country:US
Practice Address - Phone:608-769-6619
Practice Address - Fax:608-788-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 103T00000X
WI2328-57251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39133600Medicaid
MNLP5638OtherLICENSURES
WI134-140OtherLICENSURES
WI2328-57OtherLICENSURES