Provider Demographics
NPI:1609111285
Name:STAMPER, KEVIN (LPC-T)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:STAMPER
Suffix:
Gender:M
Credentials:LPC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 W KING ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3457
Mailing Address - Country:US
Mailing Address - Phone:715-362-5437
Mailing Address - Fax:715-362-2014
Practice Address - Street 1:48 W KING ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3457
Practice Address - Country:US
Practice Address - Phone:715-362-5437
Practice Address - Fax:715-362-2014
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1373-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional