Provider Demographics
NPI:1598093221
Name:CAMERON, ANDREW EDWARD (PHD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:EDWARD
Last Name:CAMERON
Suffix:
Gender:M
Credentials:PHD
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 1702
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54402-1702
Mailing Address - Country:US
Mailing Address - Phone:715-845-5493
Mailing Address - Fax:715-848-5645
Practice Address - Street 1:530 GRANT ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4738
Practice Address - Country:US
Practice Address - Phone:715-845-5493
Practice Address - Fax:715-848-5645
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4311-125101YP2500X
WI3273-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional