Individual
KELLY GANSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
1541 ANNEX RD, JEFFERSON, WI 53549-9803
(920) 728-4689
Mailing address
1541 ANNEX RD, JEFFERSON, WI 53549-9803
(920) 728-4689
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
05/11/2020
Last updated
05/11/2020
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