Provider Demographics
NPI:1255669453
Name:HAPKE, KENNETH ANDREW (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ANDREW
Last Name:HAPKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 U.S. ROUTE 2B
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9191
Mailing Address - Country:US
Mailing Address - Phone:206-949-7616
Mailing Address - Fax:
Practice Address - Street 1:1097 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SAINT JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2646
Practice Address - Country:US
Practice Address - Phone:206-949-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-27
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60059955103TC0700X
VT048.0134250103TC0700X
WAPSY60059955103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6711427Medicaid