Provider Demographics
NPI:1003879214
Name:KEROES, KENNETH J (MSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:J
Last Name:KEROES
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7526 EAGLEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-5987
Mailing Address - Country:US
Mailing Address - Phone:206-941-6174
Mailing Address - Fax:425-304-4088
Practice Address - Street 1:7526 EAGLEFIELD DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-5987
Practice Address - Country:US
Practice Address - Phone:206-941-6174
Practice Address - Fax:425-304-4088
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000050001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical