Provider Demographics
NPI:1871211664
Name:VANKO, CARLY
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:VANKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9359 JENNY LIND LN
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-9500
Mailing Address - Country:US
Mailing Address - Phone:608-334-0707
Mailing Address - Fax:
Practice Address - Street 1:9359 JENNY LIND LN
Practice Address - Street 2:
Practice Address - City:SAUK CITY
Practice Address - State:WI
Practice Address - Zip Code:53583-9500
Practice Address - Country:US
Practice Address - Phone:608-334-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8301-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical