Healthcare Provider Details

I. General information

NPI: 1326050857
Provider Name (Legal Business Name): KENT INTERMEDIATE SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 KNAPP ST NE
GRAND RAPIDS MI
49525-4518
US

IV. Provider business mailing address

2930 KNAPP ST NE
GRAND RAPIDS MI
49525-4518
US

V. Phone/Fax

Practice location:
  • Phone: 616-365-2395
  • Fax: 616-365-2336
Mailing address:
  • Phone: 616-365-2395
  • Fax: 616-365-2336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN ANN SZYMAS
Title or Position: ACCOUNTANT-SPECIAL PROJECTS
Credential:
Phone: 616-365-2395