Provider Demographics
NPI:1689195653
Name:VILLALPANDO, KAITLYN MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:VILLALPANDO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KAITLYN
Other - Middle Name:MARIE
Other - Last Name:MIEKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:501 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OCONTO
Mailing Address - State:WI
Mailing Address - Zip Code:54153-1612
Mailing Address - Country:US
Mailing Address - Phone:920-834-7000
Mailing Address - Fax:
Practice Address - Street 1:501 PARK AVE
Practice Address - Street 2:
Practice Address - City:OCONTO
Practice Address - State:WI
Practice Address - Zip Code:54153-1612
Practice Address - Country:US
Practice Address - Phone:920-834-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3573-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health