| Doctor Name: | KENNETH D FASBENDER |
| NPI Number: | 1508137712 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CSAC, SCIT |
| License Number: | 13112-132 |
| Business Practice Address: | 9433 County Rd J Minocqua, WI - 545489318 |
| Business Phone Number: | 7153565377 |
| Business Fax Number: | 7153565378 |
| Mailing Address: | 9433 County Rd J, MINOCQUA |
| State: | WI |
| Postal Code: | 545489318 |
| Phone Number: | 7153565377 |
| Fax Number: | 7153565378 |
| NPI Enumeration Date: | 01/19/2012 |
| NPI Last Update Date: | 01/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 13112-132 |
| 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: | |