KENNETH LAMAR PRUST

BEAVER DAM, WI
NPI1134113178
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: WI  6795-123)
Enumeration Date2005-09-06
Last Update Date2007-07-09
Business Address
-- KENNETH LAMAR PRUST LCSW
1200 N CENTER ST
BEAVER DAM, WI 53916-1148
Phone number: 920-887-3171
Mailing Address
-- KENNETH LAMAR PRUST LCSW
N7377 MALIBOU LN
BEAVER DAM, WI 53916-9534
Phone number: 920-887-2517
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