Healthcare Provider Details

I. General information

NPI: 1194354050
Provider Name (Legal Business Name): KEITH ALLEN KAMPHUIS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 N MITCHELL ST
CADILLAC MI
49601-1139
US

IV. Provider business mailing address

1500 WEISS ST
SAGINAW MI
48602-5251
US

V. Phone/Fax

Practice location:
  • Phone: 989-497-2500
  • Fax: 989-732-7522
Mailing address:
  • Phone: 989-497-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801115992
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: