Provider Demographics
NPI:1821611591
Name:KAVANAUGH VANDERLOOP, SATIA (MS, CRC, LPC, CSAC)
Entity type:Individual
Prefix:
First Name:SATIA
Middle Name:
Last Name:KAVANAUGH VANDERLOOP
Suffix:
Gender:F
Credentials:MS, CRC, LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 HOOVER AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-2308
Mailing Address - Country:US
Mailing Address - Phone:920-419-5771
Mailing Address - Fax:
Practice Address - Street 1:2194 EASTRIDGE CTR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3403
Practice Address - Country:US
Practice Address - Phone:715-598-1568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8552-125101YP2500X
WI17122-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)