Healthcare Provider Details

I. General information

NPI: 1043742307
Provider Name (Legal Business Name): KAREN KEWISH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5990 VENTURE PARK DR
KALAMAZOO MI
49009
US

IV. Provider business mailing address

5990 VENTURE PARK DR
KALAMAZOO MI
49009-1858
US

V. Phone/Fax

Practice location:
  • Phone: 269-532-1470
  • Fax:
Mailing address:
  • Phone: 269-532-1470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801100750
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801100750
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: