| Doctor Name: | RICHARD L KAMMERUD |
| NPI Number: | 1902029663 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW LCSW |
| License Number: | 587 123 |
| Business Practice Address: | 100 Polk County Plz Suite 50 Balsam Lake, WI - 548109071 |
| Business Phone Number: | 7154858492 |
| Business Fax Number: | 7154858490 |
| Mailing Address: | Po Box 373, BALSAM LAKE |
| State: | WI |
| Postal Code: | 548100373 |
| Phone Number: | 7154853024 |
| Fax Number: | |
| NPI Enumeration Date: | 04/11/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 587 123 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |