Prust, Kenneth Lamar

Prust, Kenneth Lamar is an individual health care provider with primary practice located at 1200 N Center St , Beaver Dam WI 53916-1148. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Prust, Kenneth Lamar can be contacted via phone (920) 887-3171.

Contact Information

Primary practice address
1200 N Center St Beaver Dam WI 53916-1148
Phone: (920) 887-3171
Fax: (920) 887-8662
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 6795-123 Wisconsin

Profile Details

NPI number 1134113178
LBN Legal business name Prust, Kenneth Lamar
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 6th, 2005
Last updated Jul 9th, 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134113178 NPPES
Wisconsin MEDICAID 43579800

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