Provider Demographics
NPI:1023197571
Name:WAHLEN, KELLY JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JEAN
Last Name:WAHLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:JEAN
Other - Last Name:HOAGLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2025 E NEWPORT AVE BLDG D7TH
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2906
Mailing Address - Country:US
Mailing Address - Phone:414-229-7429
Mailing Address - Fax:
Practice Address - Street 1:2025 E NEWPORT AVE BLDG D7TH
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2906
Practice Address - Country:US
Practice Address - Phone:414-229-7429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2249562084P0800X
WI54814-202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry