Provider Demographics
NPI:1467859637
Name:KONRAD, PAIGE M (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:M
Last Name:KONRAD
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:M
Other - Last Name:TURRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT, LPC
Mailing Address - Street 1:1500 N 34TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-4477
Mailing Address - Country:US
Mailing Address - Phone:715-395-5380
Mailing Address - Fax:715-394-2682
Practice Address - Street 1:1500 N 34TH ST STE 200
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-4477
Practice Address - Country:US
Practice Address - Phone:715-395-5380
Practice Address - Fax:715-394-2682
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2383101YP2500X
WI1109-124106H00000X
WI6817-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6817-125OtherLPC LICENSE
WI1109-124OtherLMFT LICENSE