Provider Demographics
NPI:1386652865
Name:WOLFE, KERRY J (LPC)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:J
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KERRY
Other - Middle Name:J
Other - Last Name:JUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1046 EAST ST APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-2642
Mailing Address - Country:US
Mailing Address - Phone:920-723-1639
Mailing Address - Fax:
Practice Address - Street 1:162 W MAIN ST
Practice Address - Street 2:SUITE G
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1995
Practice Address - Country:US
Practice Address - Phone:920-728-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3517125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39184249628OtherUNITY HEALTH INS WATERTOW
WI13798OtherDEAN HEALTH INSU
WI209292OtherPHYSICIANS PLUS
WI40982700H0Medicaid
WI353740OtherMHN INSURANCE
WI39184249629OtherUNITY INSURANCE LAKE MILL