| Doctor Name: | KEVIN WAHL |
| NPI Number: | 1174994164 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 2405226 |
| Business Practice Address: | 1021 E Fitzsimmons Rd Oak Creek, WI - 531545205 |
| Business Phone Number: | 4149752843 |
| Business Fax Number: | |
| Mailing Address: | 1021 E Fitzsimmons Rd, OAK CREEK |
| State: | WI |
| Postal Code: | 531545205 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/15/2015 |
| NPI Last Update Date: | 10/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 2405226 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |