Healthcare Provider Details

I. General information

NPI: 1033882675
Provider Name (Legal Business Name): CHRIS L KENWARD MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 PARCHMENT DR SE STE 100
GRAND RAPIDS MI
49546-2307
US

IV. Provider business mailing address

4078 TALLMAN CREEK DR NW
GRAND RAPIDS MI
49534-8440
US

V. Phone/Fax

Practice location:
  • Phone: 616-633-9991
  • Fax:
Mailing address:
  • Phone: 616-633-9991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801068904
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: