Provider Demographics
NPI:1700971892
Name:KRAMPETZ, CAROL HERZIG (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:HERZIG
Last Name:KRAMPETZ
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:L
Other - Last Name:HERZIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 S 1ST ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5926
Mailing Address - Country:US
Mailing Address - Phone:360-336-2361
Mailing Address - Fax:
Practice Address - Street 1:520 S 1ST ST
Practice Address - Street 2:SUITE 207
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5926
Practice Address - Country:US
Practice Address - Phone:360-336-2361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW600718921041C0700X
NH2231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE4079Medicare ID - Type Unspecified