Provider Demographics
NPI:1992197347
Name:WINTER, KENNETH
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:WINTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 1ST AVE SE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3200
Mailing Address - Country:US
Mailing Address - Phone:319-294-1599
Mailing Address - Fax:319-294-1599
Practice Address - Street 1:4403 1ST AVE SE
Practice Address - Street 2:SUITE 307
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3200
Practice Address - Country:US
Practice Address - Phone:319-294-1599
Practice Address - Fax:319-294-1599
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)