KENNETH LAMAR PRUST (NPI# 1134113178) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134113178 |
| Entity Type | Individual |
| Full Name | KENNETH LAMAR PRUST |
| Credential | LCSW |
| Practice Address |
1200 N Center St Beaver Dam WI 53916-1148 |
| Mailing Address |
N7377 Malibou Ln Beaver Dam WI 53916-9534 |
| Practice Telephone | 9208873171 |
| Practice Fax Number | 9208878662 |
| Mailing Telephone | 9208872517 |
| Mailing Fax Number | 9208878662 |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
6795-123 | WI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 43579800 | 05 |
| Street Address |
1200 N CENTER ST |
| City | BEAVER DAM |
| State | WI |
| Zip Code | 53916-1148 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083742951 | Kayla Margaret Waldschmidt | Counselor | 1200 N Center St, Lower Level-suite A, Beaver Dam, WI 53916-1166 | 2007-03-01 |
| 1972638427 | Lori Marie Thuli | Marriage & Family Therapist | 1200 N Center St, Beaver Dam, WI 53916-1166 | 2007-02-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538718283 | Paulette Neibauer | Technician | N7262 Farwell Rd., Beaver Dam, WI 53916 | 2019-09-05 |
| 1902336597 | Tricounty Homecare Inc | In Home Supportive Care | 140 Corporate Dr Ste 2, Beaver Dam, WI 53916 | 2017-06-15 |
| 1528502754 | Jessica Marie Blatz | Counselor | 809 Park Aveune, Beaver Dam, WI 53916 | 2016-12-07 |
| 1376090886 | Beaver Dam Hearing Care, LLC | Hearing Aid Equipment | 705 University Ave, Suite 170, Beaver Dam, WI 53916 | 2016-09-01 |
| 1275902546 | Beaver Dam Community Hospitals Inc | Pharmacy | 705 S University Ave Ste 180, Beaver Dam, WI 53916 | 2015-09-17 |
| 1609242825 | Tami Joe Delisle | Counselor | 207 North Spring Street, Beaver Dam, WI 53916 | 2015-08-12 |
| 1366833394 | Beaver Dam Community Hospitals, Inc | Surgery | 705 S University Ave Ste 350, Beaver Dam, WI 53916 | 2015-02-12 |
| 1326471608 | Raquel Rodriguez-guzman | Pharmacist | 205 La Crosse Street, Beaver Dam, WI 53916 | 2013-08-09 |
| 1558608828 | Mary Y Kunz | Licensed Practical Nurse | 6550 N Highway 151 Lot 63, Beaverdam, WI 53916 | 2013-01-07 |
| 1881938454 | Brock Holden Slinger | Physical Therapist | 205 Monroe St. #13, Beaver Dam, WI 53916 | 2012-11-20 |
| Find all providers in zip 53916 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467051706 | Emily Worth | Counselor | 1426 Hiawatha Dr, Beaver Dam, WI 53916-1042 | 2020-10-19 |
| 1528502754 | Jessica Marie Blatz | Counselor | 809 Park Aveune, Beaver Dam, WI 53916 | 2016-12-07 |
| 1609242825 | Tami Joe Delisle | Counselor | 207 North Spring Street, Beaver Dam, WI 53916 | 2015-08-12 |
| 1710227699 | Krystle Schmitz | Counselor | 200 Front St Ste 3d, Beaver Dam, WI 53916-1667 | 2013-02-28 |
| 1932723350 | Jaime Gregory | Counselor | 1269 Duvall Rd, Beaver Dam, KY 42320-8637 | 2020-06-01 |
| 1679133912 | Steven Fricke | Counselor | 1807 N Center St, Beaver Dam, WI 53916-1001 | 2019-06-18 |
| 1649765355 | Elizabeth Marie Szalewski | Counselor | 207 N Spring St, Beaver Dam, WI 53916-2115 | 2018-06-25 |
| 1407349657 | Unmasked Expressive Therapies | Counselor | 207 N Spring St, Beaver Dam, WI 53916-2115 | 2018-06-12 |
| 1669824744 | Aspire Behavioral Therapy, LLC | Counselor | 343 S Main St, Beaver Dam, KY 42320 | 2016-07-12 |
| 1871950022 | Jean Blair Meyer | Counselor | 115 N Center St, Beaver Dam, WI 53916-2119 | 2016-01-19 |
| Find all providers in BEAVER DAM | ||||
| City | BEAVER DAM |
| Zip Code | 53916 |
Please comment or provide details below to improve the information on KENNETH LAMAR PRUST.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.