Individual
OLYVIA RAE KENWORTHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3936 CIRCLE DR, HOLMEN, WI 54636-9187
(608) 413-4825
Mailing address
1117 WEST AVE S, LA CROSSE, WI 54601-5552
(608) 633-0032
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
106S00000X
WI
Other
Enumeration date
06/09/2025
Last updated
06/09/2025
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