Keniston, Wanda J
Keniston, Wanda J is an individual health care provider with primary practice located at 6717 Stone Glen Dr. , Middleton WI 53562. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Keniston, Wanda J can be contacted via phone (608) 220-0738.Contact Information
Primary practice address
6717 Stone Glen Dr.
Middleton WI 53562
Phone: (608) 220-0738
Fax: (608) 827-7100
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 3320 | Wisconsin |
Profile Details
| NPI number | 1457329336 |
|---|---|
| LBN Legal business name | Keniston, Wanda J |
| Credentials | MS |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 8th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 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 | 1457329336 | NPPES |
| Wisconsin | MEDICAID | 40956200 |
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