Healthcare Provider Details

I. General information

NPI: 1982904132
Provider Name (Legal Business Name): SHELDON KRANENDONK MA, LLPC, CAAC, IMH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N M 129
PICKFORD MI
49774-9204
US

IV. Provider business mailing address

PO BOX 506
PICKFORD MI
49774-0506
US

V. Phone/Fax

Practice location:
  • Phone: 906-647-2217
  • Fax:
Mailing address:
  • Phone: 906-647-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401011522
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: