Individual
TREVOR KONETZKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SAC-IT
Contact information
Practice address
201 S GLENRIDGE CT, APPLETON, WI 54914-3905
(920) 731-3981
Mailing address
201 S GLENRIDGE CT, APPLETON, WI 54914-3905
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19489-130
WI
Other
Enumeration date
02/08/2022
Last updated
02/08/2022
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