Provider Demographics
NPI:1427202902
Name:SELLKE, KRISTIN (MA, LPC, ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:SELLKE
Suffix:
Gender:F
Credentials:MA, LPC, ATR-BC
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:SELLKE
Other - Last Name:KOEPKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, ATR-BC
Mailing Address - Street 1:15460 W CAPITOL DR STE 222
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2632
Mailing Address - Country:US
Mailing Address - Phone:414-308-0886
Mailing Address - Fax:
Practice Address - Street 1:15460 W CAPITOL DR STE 222
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2632
Practice Address - Country:US
Practice Address - Phone:414-308-0886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4080-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional