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NPI Code Detail

MEDICARE: SHEKEMA KING SAC-IT

MEDICARE: SHEKEMA KING SAC-IT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor21141-30WI

General Provider Information

NPI Number : 1831026582
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHEKEMA KING SAC-IT
Provider Business Mailing Address
First Line : 3825 39TH AVE STE 120
Second Line :
City : KENOSHA
State : WI
Zip : 53144-2043
Country : US
Telephone Number : 262-946-5752
Fax Number : 262-946-5765
Provider Business Practice Location Address
First Line : 3825 39TH AVE STE 120
Second Line :
City : KENOSHA
State : WI
Zip : 53144-2043
Country : US
Telephone Number : 262-946-5752
Fax Number : 262-946-5765
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2026
Last Update Date : 05/06/2026

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Directions to “ SHEKEMA KING SAC-IT” Practice Location

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