Healthcare Provider Details

I. General information

NPI: 1023101078
Provider Name (Legal Business Name): KEVIN D VREDEVELD LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MICHIGAN AVE W
BATTLE CREEK MI
49017-3602
US

IV. Provider business mailing address

140 MICHIGAN AVE W
BATTLE CREEK MI
49017-3602
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-1460
  • Fax:
Mailing address:
  • Phone: 269-966-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801070171
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: