Individual
KENNETH SANTANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SAC-IT
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
17228-130
WI
Other
Enumeration date
09/05/2014
Last updated
09/05/2014
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