| Doctor Name: | MR. KENNETH A SIECZKOWSKI |
| NPI Number: | 1154473809 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CADC-III |
| License Number: | 13092 |
| Business Practice Address: | 12970 W Bluemound Rd 308 Elm Grove, WI - 531222607 |
| Business Phone Number: | 2627801020 |
| Business Fax Number: | 2627801022 |
| Mailing Address: | 12970 W Bluemound Rd, 308 ELM GROVE |
| State: | WI |
| Postal Code: | 531222607 |
| Phone Number: | 2627801020 |
| Fax Number: | 2627801022 |
| NPI Enumeration Date: | 01/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 13092 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |