Individual
WANDA J KENISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
6717 STONE GLEN DR., MIDDLETON, WI 53562
(608) 220-0738
(608) 827-7100
Mailing address
709 E MAIN ST, STOUGHTON, WI 53589-1834
(608) 877-0268
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3320
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40956200
—
WI
Enumeration date
03/08/2006
Last updated
07/08/2007
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