Healthcare Provider Details

I. General information

NPI: 1295275006
Provider Name (Legal Business Name): KENNETH SNART
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 HIGHLAND AVE 2005 HIGHLAND AVENUE
EAU CLAIRE WI
54701-4455
US

IV. Provider business mailing address

2005 HIGHLAND AVE 2005 HIGHLAND AVENUE
EAU CLAIRE WI
54701-4455
US

V. Phone/Fax

Practice location:
  • Phone: 715-832-5454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1602-132
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: