Provider Demographics
NPI:1619278744
Name:LOBENSTEIN, KENNETH G (CSW)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:G
Last Name:LOBENSTEIN
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WELCH PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:NEW LISBON
Mailing Address - State:WI
Mailing Address - Zip Code:53950-1506
Mailing Address - Country:US
Mailing Address - Phone:608-547-7931
Mailing Address - Fax:
Practice Address - Street 1:708 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-2372
Practice Address - Country:US
Practice Address - Phone:608-381-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8528-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker