Healthcare Provider Details

I. General information

NPI: 1568402923
Provider Name (Legal Business Name): KENNETH HERRING LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 FRANKFORT HWY SUITE 200
BENZONIA MI
49616-9558
US

IV. Provider business mailing address

4651 RUSH LAKE TRL
HONOR MI
49640-9442
US

V. Phone/Fax

Practice location:
  • Phone: 231-882-2273
  • Fax: 231-882-2360
Mailing address:
  • Phone: 231-882-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801034954
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: