Provider Demographics
NPI:1083786933
Name:KEESSEN, KIMBERLY S (AUD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:KEESSEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3521
Mailing Address - Country:US
Mailing Address - Phone:231-755-0552
Mailing Address - Fax:231-755-0560
Practice Address - Street 1:941 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-3521
Practice Address - Country:US
Practice Address - Phone:231-755-0552
Practice Address - Fax:231-755-0560
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000193231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI64-0F10164OtherBCBSM