Provider Demographics
NPI:1386391175
Name:KEMP, MICHAEL E (CSAC, NCAC I)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:KEMP
Suffix:
Gender:M
Credentials:CSAC, NCAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 W GLEN OAKS LN # 205
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3467
Mailing Address - Country:US
Mailing Address - Phone:414-235-0431
Mailing Address - Fax:
Practice Address - Street 1:1045 W GLEN OAKS LN # 205
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3467
Practice Address - Country:US
Practice Address - Phone:414-235-0431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11269-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty