Provider Demographics
NPI:1912644048
Name:WARTGOW, CORYNN KATHLEEN (MS LPC, SAC-IT)
Entity type:Individual
Prefix:
First Name:CORYNN
Middle Name:KATHLEEN
Last Name:WARTGOW
Suffix:
Gender:
Credentials:MS LPC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 WILSON AVE RM 330
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2746
Mailing Address - Country:US
Mailing Address - Phone:715-256-7166
Mailing Address - Fax:888-427-8048
Practice Address - Street 1:800 WILSON AVE RM 330
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2746
Practice Address - Country:US
Practice Address - Phone:715-256-7166
Practice Address - Fax:888-427-8048
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI19533-130101YA0400X
WI11329-125101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)