Provider Demographics
NPI:1124901277
Name:HENDRICKSON, KAM RENEE
Entity type:Individual
Prefix:
First Name:KAM
Middle Name:RENEE
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8539 OKLAHOMA 82
Mailing Address - Street 2:
Mailing Address - City:HULBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74441
Mailing Address - Country:US
Mailing Address - Phone:539-234-9187
Mailing Address - Fax:
Practice Address - Street 1:8539 OKLAHOMA 82
Practice Address - Street 2:
Practice Address - City:HULBERT
Practice Address - State:OK
Practice Address - Zip Code:74441
Practice Address - Country:US
Practice Address - Phone:539-234-9187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)