Healthcare Provider Details

I. General information

NPI: 1407920432
Provider Name (Legal Business Name): KERRI MICHELLE KENEL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 E. EDGERTON ST.
HOWARD CITY MI
49329
US

IV. Provider business mailing address

5305 W RIVER DR NE
COMSTOCK PARK MI
49321-8527
US

V. Phone/Fax

Practice location:
  • Phone: 231-937-9959
  • Fax: 231-937-4361
Mailing address:
  • Phone: 616-644-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801078230
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: