Healthcare Provider Details

I. General information

NPI: 1740707272
Provider Name (Legal Business Name): DEBORAH KENNEDY-KUIPER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 E BELTLINE AVE NE STE 204
GRAND RAPIDS MI
49525-7064
US

IV. Provider business mailing address

201 MONROE AVE NW STE 300
GRAND RAPIDS MI
49503-2212
US

V. Phone/Fax

Practice location:
  • Phone: 800-600-4096
  • Fax:
Mailing address:
  • Phone: 616-328-6600
  • Fax: 866-606-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801097728
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: