Provider Demographics
NPI:1891359576
Name:KENNETH GINLACK SR CONSULTING SERVICES LLC
Entity Type:Organization
Organization Name:KENNETH GINLACK SR CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GINLACK
Authorized Official - Suffix:SR
Authorized Official - Credentials:LCSW,CSAC,ICS
Authorized Official - Phone:414-236-0083
Mailing Address - Street 1:3927 S HOWELL AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-4421
Mailing Address - Country:US
Mailing Address - Phone:414-600-4823
Mailing Address - Fax:
Practice Address - Street 1:3927 S HOWELL AVE STE 102
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-4421
Practice Address - Country:US
Practice Address - Phone:414-600-4823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-27
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty