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Organization
KEN SANN
Active
Organization
KEN SANN
Active
Other names
Independent Assessment & Counseling Services
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH ROY SANN (OWNER)
(920) 438-8141
Entity
Organization
Contact information
Practice address
1345 W MASON ST, SUITE 200, GREEN BAY, WI 54303-2049
(920) 438-8141
(920) 438-7993
Mailing address
1345 W MASON ST, SUITE 200, GREEN BAY, WI 54303-2049
(920) 438-8141
(920) 438-7993
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1722-132
WI
101YM0800X
Mental Health Counselor
2313
WI
104100000X
Social Worker
2221-120
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42224300
—
WI
Enumeration date
02/14/2007
Last updated
07/03/2008
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