Individual
KOLTON DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3000 W SPENCER ST APT B18, APPLETON, WI 54914-4354
(920) 540-4190
Mailing address
1308 N LEONA ST, APPLETON, WI 54911-4232
(920) 730-1028
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/22/2019
Last updated
07/22/2019
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