Healthcare Provider Details

I. General information

NPI: 1942652730
Provider Name (Legal Business Name): STACEY VEENSTRA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 02/03/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 N 10TH ST STE 110
KALAMAZOO MI
49009-5733
US

IV. Provider business mailing address

1090 N 10TH ST STE 110
KALAMAZOO MI
49009-5733
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-4363
  • Fax:
Mailing address:
  • Phone: 269-375-4363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801096148
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: