MEDICARE: MISS SANDRA SUE KAMMER MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	6801016997	MI
2	1041C0700X	Clinical Social Worker	6801016997	MI

General Provider Information

NPI Number	:	1265548515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SANDRA SUE KAMMER MSW

Provider Business Mailing Address
First Line	:	3947 ARLINGTON AVE
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3764
Country	:	US
Telephone Number	:	810-984-2250
Fax Number	:

Provider Business Practice Location Address
First Line	:	3947 ARLINGTON AVE
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3764
Country	:	US
Telephone Number	:	810-984-2250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	06/20/2024

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