Provider Demographics
NPI:1508407545
Name:VANDERLOOP, MORGAN L (LPC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:L
Last Name:VANDERLOOP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:920-766-3200
Mailing Address - Fax:920-759-3000
Practice Address - Street 1:1500 ARBOR WAY
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-7305
Practice Address - Country:US
Practice Address - Phone:920-766-3200
Practice Address - Fax:920-759-3000
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7498-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100094476Medicaid