Individual
MR. KENNETH EISENBERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW, DCSW
Contact information
Practice address
1303 S O ST, PORT ANGELES, WA 98363-1218
(360) 626-1457
(360) 626-1457
Mailing address
17183 CLEAR CREEK RD NW, POULSBO, WA 98370-7225
(360) 626-1457
(360) 626-1457
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW00005218
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8511768
—
WA
01
—
G8902184
MEDICARE
WA
Enumeration date
07/27/2005
Last updated
01/23/2024
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