Healthcare Provider Details

I. General information

NPI: 1558398099
Provider Name (Legal Business Name): KATHLEEN KRESSE KEEDER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 AVENUE A
SPRINGFIELD MI
49037-8374
US

IV. Provider business mailing address

46 AVENUE A
SPRINGFIELD MI
49037-8374
US

V. Phone/Fax

Practice location:
  • Phone: 269-420-8665
  • Fax:
Mailing address:
  • Phone: 269-420-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801082923
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: