Provider Demographics
NPI:1356656789
Name:KEMPER, JACOB WILLIAM (RDMS (AB))
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:WILLIAM
Last Name:KEMPER
Suffix:
Gender:M
Credentials:RDMS (AB)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 ORLEANS ST W APT 221A
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6579
Mailing Address - Country:US
Mailing Address - Phone:715-864-6067
Mailing Address - Fax:
Practice Address - Street 1:2225 ORLEANS ST W APT 221A
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6579
Practice Address - Country:US
Practice Address - Phone:715-864-6067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1140182471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography