Individual
LORI ANNE DECARLO-KIENITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
502 MAIN ST W STE 305, ASHLAND, WI 54806-1512
(715) 682-5207
(715) 682-5209
Mailing address
201 E PINE ST, IRONWOOD, MI 49938-2823
(906) 932-4329
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14014-132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39166400
—
WI
Enumeration date
03/30/2007
Last updated
07/09/2007
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