Provider Demographics
NPI:1437874740
Name:KAMMERER, BRAYDON RAY
Entity Type:Individual
Prefix:
First Name:BRAYDON
Middle Name:RAY
Last Name:KAMMERER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 S 12TH ST APT 1102
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-2611
Mailing Address - Country:US
Mailing Address - Phone:253-548-4802
Mailing Address - Fax:
Practice Address - Street 1:5401 S 12TH ST APT 1102
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-2611
Practice Address - Country:US
Practice Address - Phone:253-548-4802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWDL2TRPJ133B101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor