Provider Demographics
NPI:1639875818
Name:WOGAHN, KAL SHORE (LPC)
Entity type:Individual
Prefix:
First Name:KAL
Middle Name:SHORE
Last Name:WOGAHN
Suffix:
Gender:X
Credentials:LPC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:WOGAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1882 E MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5288
Mailing Address - Country:US
Mailing Address - Phone:608-284-8271
Mailing Address - Fax:
Practice Address - Street 1:1882 E MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5288
Practice Address - Country:US
Practice Address - Phone:608-284-8271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7220101YP2500X
WI11242-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11242-125OtherWI DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES