Individual
KYLE J PROROK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
400 CONGRESS AVE, VIROQUA, WI 54665-1309
(608) 632-9176
(608) 637-8000
Mailing address
E10671 GORE HOLLOW RD, VIOLA, WI 54664-8054
(608) 632-9176
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
1607-226
WI
101YP2500X
Professional Counselor
Primary
5504-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376976738
—
WI
Enumeration date
08/20/2013
Last updated
08/25/2021
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