Provider Demographics
NPI:1750609210
Name:TESSEN, KENNETH DUANE (SACIT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DUANE
Last Name:TESSEN
Suffix:
Gender:M
Credentials:SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PRENTICE ST N
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1162
Mailing Address - Country:US
Mailing Address - Phone:715-345-0711
Mailing Address - Fax:715-345-0223
Practice Address - Street 1:201 PRENTICE ST N
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1162
Practice Address - Country:US
Practice Address - Phone:715-345-0711
Practice Address - Fax:715-345-0223
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-08
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14930-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)