Provider Demographics
NPI:1134119456
Name:KAMPS, GEORGE J (MSW,ACSW, LCSW)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:KAMPS
Suffix:
Gender:M
Credentials:MSW,ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8067
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54308-8067
Mailing Address - Country:US
Mailing Address - Phone:920-432-0600
Mailing Address - Fax:
Practice Address - Street 1:1922 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-1880
Practice Address - Country:US
Practice Address - Phone:920-432-0600
Practice Address - Fax:920-432-9194
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2341-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39500800Medicaid
WIE73537Medicare UPIN
WI000584133Medicare ID - Type Unspecified