Provider Demographics
NPI:1063023869
Name:KLEINHEKSEL, CADAN ROBERT (HIS)
Entity Type:Individual
Prefix:
First Name:CADAN
Middle Name:ROBERT
Last Name:KLEINHEKSEL
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1556
Mailing Address - Country:US
Mailing Address - Phone:616-847-3144
Mailing Address - Fax:616-847-8416
Practice Address - Street 1:1101 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1556
Practice Address - Country:US
Practice Address - Phone:616-847-3144
Practice Address - Fax:616-847-8416
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501009060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist