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NPI Code Detail

MEDICARE: KERRY HAMMERSCHMITH LCSW, CADCII, MAC

MEDICARE: KERRY HAMMERSCHMITH LCSW, CADCII, MAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor06-03-56OR
21041C0700XClinical Social WorkerL6546OR

General Provider Information

NPI Number : 1629102645
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRY HAMMERSCHMITH LCSW, CADCII, MAC
Provider Business Mailing Address
First Line : PO BOX 5752
Second Line :
City : SALEM
State : OR
Zip : 97304-0752
Country : US
Telephone Number : 503-269-3834
Fax Number :
Provider Business Practice Location Address
First Line : 182 SW ACADEMY ST
Second Line :
City : DALLAS
State : OR
Zip : 97338-1996
Country : US
Telephone Number : 503-569-5386
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 09/14/2020

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