Provider Demographics
NPI:1033882675
Name:KENWARD, CHRIS L (MSW)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:L
Last Name:KENWARD
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 1:4078 TALLMAN CREEK DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-8440
Mailing Address - Country:US
Mailing Address - Phone:616-633-9991
Mailing Address - Fax:
Practice Address - Street 1:826 PARCHMENT DR SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2307
Practice Address - Country:US
Practice Address - Phone:616-633-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010689041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty