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Individual

MR. DOUGLAS L KUNICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSSW LCSW

Contact information

Practice address
808 MAIN ST E, MENOMONIE, WI 54751-2735
(715) 232-1116
Mailing address
1437 BELL ST, EAU CLAIRE, WI 54703-5017
(715) 834-7955

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9-123
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1016363
PREFERREDONE INS PIN
WI
01
18934
MMSI PROVIDER NUMBER
MN
01
2418
SECURITY HEALTH PLAN ID
WI
05
39715300
WI
Enumeration date
05/22/2006
Last updated
07/09/2007
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