Clark, Kenneth W

Clark, Kenneth W is an individual health care provider with primary practice located at 6510 Grand Teton Plz Suite 406, Madison WI 53719-1029. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Clark, Kenneth W can be contacted via phone (608) 833-9290.

Contact Information

Primary practice address
6510 Grand Teton Plz Suite 406 Madison WI 53719-1029
Phone: (608) 833-9290
Fax: (608) 833-9691
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 670-057 Wisconsin

Profile Details

NPI number 1942254560
LBN Legal business name Clark, Kenneth W
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date May 19th, 2006
Last updated Mar 20th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942254560 NPPES
Wisconsin Other 11676 DEAN
Wisconsin MEDICAID 39012000 DEAN

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