Provider Demographics
NPI:1881287035
Name:WEVERKA, KAYLEEN PATRICIA (LPCC)
Entity type:Individual
Prefix:
First Name:KAYLEEN
Middle Name:PATRICIA
Last Name:WEVERKA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 JACOB ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:MN
Mailing Address - Zip Code:55339-9404
Mailing Address - Country:US
Mailing Address - Phone:651-283-8284
Mailing Address - Fax:
Practice Address - Street 1:145 JACOB ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:MN
Practice Address - Zip Code:55339-9404
Practice Address - Country:US
Practice Address - Phone:651-283-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02563101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor