Individual
KENNETH ROY SANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, CSAC, ICS
Contact information
Practice address
1061 W MASON ST, GREEN BAY, WI 54303-1858
(920) 437-8256
Mailing address
1061 W MASON ST, GREEN BAY, WI 54303-1858
(920) 437-8256
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
WI
Other
Enumeration date
12/05/2018
Last updated
12/05/2018
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