MEDICARE: KATHLEEN KRESSE KEEDER LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801082923	MI

General Provider Information

NPI Number	:	1558398099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN KRESSE KEEDER LMSW

Provider Business Mailing Address
First Line	:	46 AVENUE A
Second Line	:
City	:	SPRINGFIELD
State	:	MI
Zip	:	49037-8374
Country	:	US
Telephone Number	:	269-420-8665
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 AVENUE A
Second Line	:
City	:	SPRINGFIELD
State	:	MI
Zip	:	49037-8374
Country	:	US
Telephone Number	:	269-420-8665
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	01/25/2013

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