Provider Demographics
NPI:1982987368
Name:UTECH, KENNETH G (MSW)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:G
Last Name:UTECH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 PACKERLAND DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-6810
Mailing Address - Country:US
Mailing Address - Phone:920-983-0707
Mailing Address - Fax:920-983-0700
Practice Address - Street 1:3313 PACKERLAND DR
Practice Address - Street 2:SUITE D
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-6810
Practice Address - Country:US
Practice Address - Phone:920-983-0707
Practice Address - Fax:920-983-0700
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI393-1231041C0700X
WI74124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical