Healthcare Provider Details

I. General information

NPI: 1437903523
Provider Name (Legal Business Name): KENNEDY ANN LEWIS BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VISTA DR
COLDWATER MI
49036-1776
US

IV. Provider business mailing address

200 VISTA DR
COLDWATER MI
49036-1776
US

V. Phone/Fax

Practice location:
  • Phone: 269-419-1881
  • Fax:
Mailing address:
  • Phone: 517-278-2129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851121193
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: