Healthcare Provider Details

I. General information

NPI: 1619191921
Provider Name (Legal Business Name): KERRY LINN HUVER MPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CASCADE WEST PKWY SE STE 240
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

2614 RICHARDS DRIVE SE
GRAND RAPIDS MI
49506-4736
US

V. Phone/Fax

Practice location:
  • Phone: 616-591-9000
  • Fax: 616-591-9060
Mailing address:
  • Phone: 616-446-9108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802079981
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013678
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: