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General NPI Number Information
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NPI Number | 1992972053
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Entity Type | Individual
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Provider Name | STEPHANIE A KEENAN LMSW
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Gender | Female
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 794 PINE ST STE 220A
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City | MUSKEGON
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State | MI
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Zip | 49442-1020
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Country | US
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Telephone | 231-740-7913
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Fax |
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Provider Business Mailing Address
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Address Line | 8781 S 116TH AVE
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City | ROTHBURY
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State | MI
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Zip | 49452-8085
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Country | US
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Telephone | 231-740-7913
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801092003
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6802084353
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License Number State | MI
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