Provider Demographics
NPI:1245997824
Name:KAKWITCH, DANIELLE MARIE (MA, LPC IT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:KAKWITCH
Suffix:
Gender:F
Credentials:MA, LPC IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:KESHENA
Mailing Address - State:WI
Mailing Address - Zip Code:54135-0970
Mailing Address - Country:US
Mailing Address - Phone:715-799-3361
Mailing Address - Fax:715-799-3929
Practice Address - Street 1:W3275 WOLF RIVER RD
Practice Address - Street 2:
Practice Address - City:KESHENA
Practice Address - State:WI
Practice Address - Zip Code:54135-0970
Practice Address - Country:US
Practice Address - Phone:715-799-3361
Practice Address - Fax:715-799-3929
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI5132-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional