Healthcare Provider Details

I. General information

NPI: 1992855464
Provider Name (Legal Business Name): KENNETH WAYNE ADAMS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 KRAFT AVE SE 186
GRAND RAPIDS MI
49512-7700
US

IV. Provider business mailing address

PO BOX 1767
GRAND RAPIDS MI
49501-1767
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-9550
  • Fax: 616-949-9551
Mailing address:
  • Phone: 616-235-2090
  • Fax: 616-235-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801021362
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: