Provider Demographics
NPI:1588843809
Name:COLE, KENNETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3267 S 16TH ST
Mailing Address - Street 2:OHIO BLDG RM 200
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4500
Mailing Address - Country:US
Mailing Address - Phone:414-389-3111
Mailing Address - Fax:414-389-3110
Practice Address - Street 1:3267 S 16TH ST
Practice Address - Street 2:OHIO BLDG RM 200
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4500
Practice Address - Country:US
Practice Address - Phone:414-389-3111
Practice Address - Fax:414-389-3110
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2220103TC0700X
CA21306103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical