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Individual

MR. KEVIN S GUNDERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.S.E.

Contact information

Practice address
2745 BAYLITE DR, GREEN BAY, WI 54313-7173
(920) 362-2152
Mailing address
1220 STUART ST, GREEN BAY, WI 54301-4313
(920) 437-1027

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5011-125
WI
101YP2500X
Professional Counselor
887-226
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100029719
WI
Enumeration date
08/12/2010
Last updated
09/14/2021
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