Knudson, Kevin A

Knudson, Kevin A is an sole proprietor health care provider with primary practice located at 533 Peace Pipe Road , Lac Du Flambeau WI 54538-0189. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Knudson, Kevin A can be contacted via phone (715) 588-1511.

Contact Information

Primary practice address
533 Peace Pipe Road Lac Du Flambeau WI 54538-0189
Phone: (715) 588-1511
Fax: (715) 588-3903
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 14432 Wisconsin

Profile Details

NPI number 1578691960
LBN Legal business name Knudson, Kevin A
Credentials CADCIII
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 28th, 2007
Last updated Jul 9th, 2007 - about 19 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 1578691960 NPPES
Wisconsin MEDICAID 39373600

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