Grizzle, Kenneth L
Grizzle, Kenneth L is an individual health care provider with primary practice located at 13800 W North Ave Child Development Center Of Chw, Brookfield WI 53005-4977. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Child & Adolescent, which is considered as his primary health care specialty. Grizzle, Kenneth L can be contacted via phone (262) 432-6600.Contact Information
Primary practice address
13800 W North Ave Child Development Center Of Chw
Brookfield WI 53005-4977
Phone: (262) 432-6600
Fax: (262) 432-6604
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical Child & Adolescent | 103TC2200X | 2187 | Wisconsin |
Profile Details
| NPI number | 1912958737 |
|---|---|
| LBN Legal business name | Grizzle, Kenneth L |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 15th, 2006 |
| Last updated | Nov 21st, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912958737 | NPPES |
| Other | 005000215G | HUMANA | |
| MEDICAID | 1912958737 | HUMANA |
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