Active NPI
Kenneth G Utech, MSW
- Marriage & Family Therapist
- De Pere, WI
National Provider Identifier
1982987368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 74124
- Practice address
- 3313 Packerland Dr
Suite D
De Pere, WI 54115-6810 - Phone
- (920) 983-0707
- Fax
- (920) 983-0700
- NPI assigned
- Sep 22, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 393-123 | WI | |
| Marriage & Family Therapist | 106H00000X | 74124 | WI | Primary |
Addresses
Primary practice location
3313 Packerland Dr
Suite D
De Pere, WI 54115-6810
Mailing address
3313 Packerland Dr
Suite D
De Pere, WI 54115-6810
Phone (920) 983-0707
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 393-123 | WI | MD | Clinical Social Worker |
| 74124 | WI | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316649600000",
"number": "1982987368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3313 PACKERLAND DR",
"address_2": "SUITE D",
"city": "DE PERE",
"state": "WI",
"postal_code": "541156810",
"telephone_number": "920-983-0707",
"fax_number": "920-983-0700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3313 PACKERLAND DR",
"address_2": "SUITE D",
"city": "DE PERE",
"state": "WI",
"postal_code": "541156810",
"telephone_number": "920-983-0707",
"fax_number": "920-983-0700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UTECH",
"first_name": "KENNETH",
"middle_name": "G",
"name_prefix": "Mr.",
"credential": "MSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-09-22",
"last_updated": "2011-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "393-123",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "WI",
"license": "74124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in De Pere, WI
- United Seating and Mobility, LLC (CorLife)
- Unity Limited Partnership (Unity)
- Unity Supportive Care Management, LLC
- Urology Associates of Green Bay Surgery Center, LLC
- Urology Associates of Green Bay, S.C.
- Abhilash R Vaishnav, MD
- Van Drisse Chiropractic Center LLC
- Alec David Van Drisse, DC
- David Mark Van Drisse, D.C.
- Ashley R Van Dyn Hoven, COTA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.