Individual
MR. KENT THOMAS KOLLATH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSAC, CSIT
Contact information
Practice address
2911 MAIN AVE, SHEBOYGAN, WI 53083-3639
(920) 254-6922
Mailing address
2911 MAIN AVE, SHEBOYGAN, WI 53083-3639
(920) 254-6922
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15399-132
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
15401-133
WI
Other
Enumeration date
04/30/2008
Last updated
06/01/2012
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