Basic Information
| Provider Information | |||||||||
| NPI: | 1326469586 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARTENSTEIN | ||||||||
| FirstName: | KENNETH | ||||||||
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| Credential: | LPC, SAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 E CALUMET RD | ||||||||
| Address2: | |||||||||
| City: | FOX POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532173425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4145400233 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1035 W GLEN OAKS LN STE 110 | ||||||||
| Address2: | |||||||||
| City: | MEQUON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530923392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622446178 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2013 | ||||||||
| LastUpdateDate: | 04/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 17040-130 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.