Healthcare Provider Details

I. General information

NPI: 1275586497
Provider Name (Legal Business Name): JAMES DAVID KRAMER CADC III, CCS II
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 COURT ST ROOM 503
NEILLSVILLE WI
54456-1971
US

IV. Provider business mailing address

901 W MCMILLAN ST
MARSHFIELD WI
54449-1019
US

V. Phone/Fax

Practice location:
  • Phone: 715-743-5208
  • Fax: 715-743-5209
Mailing address:
  • Phone: 715-387-4131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1686
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: