Provider Demographics
NPI:1639875818
Name:WOGAHN, KIMBERLY SUE (LPC-IT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:WOGAHN
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:KAL
Other - Middle Name:
Other - Last Name:WOGAHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:941 E GORHAM ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3922
Mailing Address - Country:US
Mailing Address - Phone:608-284-8271
Mailing Address - Fax:
Practice Address - Street 1:941 E GORHAM ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3922
Practice Address - Country:US
Practice Address - Phone:608-284-8271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7220101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7220OtherWI DEPARTMENT OF SAFETY & PROFESSIONAL SERVICES