Provider Demographics
NPI:1376314914
Name:VANDERVORT, KAREN THERESE (LPC-IT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:THERESE
Last Name:VANDERVORT
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 S RIVER GLEN LN APT 2
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1186
Mailing Address - Country:US
Mailing Address - Phone:309-830-9524
Mailing Address - Fax:
Practice Address - Street 1:N91W17194 APPLETON AVE STE 204
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2083
Practice Address - Country:US
Practice Address - Phone:414-502-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2304840-TRNE101Y00000X
WI8115-226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor