Individual
KALEENA J VANDERWYST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
730 SWEDE AVE, TURTLE LAKE, WI 54889-0000
(715) 986-2599
(715) 986-2521
Mailing address
15735 W US HIGHWAY 63, HAYWARD, WI 54843-6475
(715) 634-2541
(715) 934-5554
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5197
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100191525
—
WI
01
—
11071
STATE LICENSE (LPC)
WI
Enumeration date
01/14/2022
Last updated
06/10/2024
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