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General NPI Number Information
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NPI Number | 1033411939
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Entity Type | Individual
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Provider Name | JASON STUART KANTROWITZ MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 11/27/2010
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Last Update Date | 11/27/2010
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Provider Practice Location Address
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Address Line | 10042 N. BROOKDALE DR.
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City | MEQUON
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State | WI
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Zip | 53092-5702
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Country | US
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Telephone | 414-534-2979
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Fax | 262-292-8184
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Provider Business Mailing Address
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Address Line | 10042 N. BROOKDALE DR.
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City | MEQUON
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State | WI
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Zip | 53092-5702
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Country | US
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Telephone | 414-534-2979
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Fax | 262-292-8184
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4412-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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