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1457044000
SHANE BASTAR
GREEN BAY, WI
NPI
1457044000
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WI 20212-130)
Enumeration Date
2023-05-31
Last Update Date
2023-05-31
Business Address
SHANE BASTAR SAC-IT
2357 W MASON ST
GREEN BAY, WI 54303-4708
Phone number: 920-337-6740
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Mailing Address
SHANE BASTAR SAC-IT
2357 W MASON ST
GREEN BAY, WI 54303-4708
Phone number: 920-337-6740
Copy
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