Healthcare Provider Details

I. General information

NPI: 1669384418
Provider Name (Legal Business Name): LARRY WESLEY KAHL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 INTERNATIONAL LN
MADISON WI
53704-3117
US

IV. Provider business mailing address

1473 AMENDMENT DR
NEENAH WI
54956-9677
US

V. Phone/Fax

Practice location:
  • Phone: 608-205-8798
  • Fax:
Mailing address:
  • Phone: 360-515-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1265-132
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1295-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: