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General NPI Number Information
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NPI Number | 1982987368
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Entity Type | Individual
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Provider Name | KENNETH G UTECH MSW
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Gender | Male
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 3313 PACKERLAND DR SUITE D
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City | DE PERE
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State | WI
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Zip | 54115-6810
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Country | US
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Telephone | 920-983-0707
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Fax | 920-983-0700
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Provider Business Mailing Address
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Address Line | 3313 PACKERLAND DR SUITE D
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City | DE PERE
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State | WI
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Zip | 54115-6810
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Country | US
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Telephone | 920-983-0707
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Fax | 920-983-0700
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 393-123
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 74124
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License Number State | WI
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