Provider Demographics
NPI:1306801410
Name:KUSHNER, KENNETH P (PHD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:P
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6714 COLONY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1125
Mailing Address - Country:US
Mailing Address - Phone:608-833-8586
Mailing Address - Fax:
Practice Address - Street 1:701 DANE STREET
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713
Practice Address - Country:US
Practice Address - Phone:608-263-3111
Practice Address - Fax:608-263-6663
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI923103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical