| Doctor Name: | KYLE WOCKENFUSS |
| NPI Number: | 1164860102 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 9988 |
| Business Practice Address: | 3900 Dakota Ave Suite 9 South Sioux City, NE - 687763696 |
| Business Phone Number: | 4024181540 |
| Business Fax Number: | |
| Mailing Address: | 124 Elm St, VERMILLION |
| State: | SD |
| Postal Code: | 570692124 |
| Phone Number: | 4024181540 |
| Fax Number: | |
| NPI Enumeration Date: | 06/12/2013 |
| NPI Last Update Date: | 06/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 9988 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |