SHANE BASTAR

GREEN BAY, WI
NPI1457044000
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: WI  20212-130)
Enumeration Date2023-05-31
Last Update Date2023-05-31
Business Address
SHANE BASTAR SAC-IT
2357 W MASON ST
GREEN BAY, WI 54303-4708
Phone number: 920-337-6740
Mailing Address
SHANE BASTAR SAC-IT
2357 W MASON ST
GREEN BAY, WI 54303-4708
Phone number: 920-337-6740
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