Individual
SHANE BASTAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SAC-IT
Contact information
Practice address
2357 W MASON ST, GREEN BAY, WI 54303-4708
(920) 337-6740
Mailing address
2357 W MASON ST, GREEN BAY, WI 54303-4708
(920) 337-6740
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20212-130
WI
Other
Enumeration date
05/31/2023
Last updated
05/31/2023
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