Individual
DR. KENNETH A VISSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1720 EL JOBEAN RD., SUITE 111, PORT CHARLOTTE, FL 33948-1286
(941) 927-4797
(941) 927-4797
Mailing address
2246 CIRCLEWOOD DR., SARASOTA, FL 34231-5741
(941) 927-4797
(941) 927-4797
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY0002667
FL
103T00000X
Psychologist
PY2667
FL
Other
Enumeration date
06/03/2006
Last updated
06/20/2012
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