Provider Demographics
NPI:1124578786
Name:KOLLER KUNDE, EMILY (LPC-IT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KOLLER KUNDE
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9003 POLIFKA RD
Mailing Address - Street 2:
Mailing Address - City:WHITELAW
Mailing Address - State:WI
Mailing Address - Zip Code:54247-9782
Mailing Address - Country:US
Mailing Address - Phone:920-403-0021
Mailing Address - Fax:
Practice Address - Street 1:9003 POLIFKA RD
Practice Address - Street 2:
Practice Address - City:WHITELAW
Practice Address - State:WI
Practice Address - Zip Code:54247-9782
Practice Address - Country:US
Practice Address - Phone:920-403-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2206-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional