Individual
KATIE KOEBERNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-IT
Contact information
Practice address
424 S MONROE AVE STE 201, GREEN BAY, WI 54301-4054
(920) 445-0170
(920) 445-0174
Mailing address
2691 VIOLET LN, GREEN BAY, WI 54313-6080
(479) 305-3081
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
18335-130
WI
101YM0800X
Mental Health Counselor
Primary
2593-226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427421023
—
WI
Enumeration date
11/04/2015
Last updated
10/09/2018
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