Individual
KRISTA L DOERR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1541 ANNEX RD, JEFFERSON, WI 53549-9803
(920) 674-8190
(920) 674-6113
Mailing address
1541 ANNEX RD, JEFFERSON, WI 53549-9803
(920) 674-8190
(920) 674-6113
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
3826-125
WI
101YP2500X
Professional Counselor
Primary
3826-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669602413
—
WI
Enumeration date
07/14/2009
Last updated
11/01/2010
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