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General NPI Number Information
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NPI Number | 1629102645
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Entity Type | Individual
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Provider Name | KERRY HAMMERSCHMITH LCSW, CADCII, MAC
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 182 SW ACADEMY ST
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City | DALLAS
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State | OR
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Zip | 97338-1996
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Country | US
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Telephone | 503-569-5386
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5752
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City | SALEM
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State | OR
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Zip | 97304-0752
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Country | US
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Telephone | 503-269-3834
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 06-03-56
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L6546
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License Number State | OR
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