Individual
KENNETH R NINHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSE
Contact information
Practice address
129 OLD ABE RD, LAC DU FLAMBEAU, WI 54538-9386
(715) 588-3371
(715) 588-2031
Mailing address
129 OLD ABE RD, LAC DU FLAMBEAU, WI 54538-9386
(715) 588-3371
(715) 588-2031
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1060-132
WI
101YM0800X
Mental Health Counselor
2624-120
WI
101YP2500X
Professional Counselor
11915-134
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39231600
—
WI
Enumeration date
10/27/2005
Last updated
06/27/2016
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