Provider Demographics
NPI:1336469824
Name:AYRES, KAMI MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KAMI
Middle Name:MARIE
Last Name:AYRES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 RED CEDAR ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2338
Mailing Address - Country:US
Mailing Address - Phone:715-231-2010
Mailing Address - Fax:715-231-2070
Practice Address - Street 1:392 RED CEDAR ST STE 3B
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2338
Practice Address - Country:US
Practice Address - Phone:715-231-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7641-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI013500015OtherMEDICARE