Provider Demographics
NPI:1558398099
Name:KEEDER, KATHLEEN KRESSE (LMSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KRESSE
Last Name:KEEDER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49037-8374
Mailing Address - Country:US
Mailing Address - Phone:269-420-8665
Mailing Address - Fax:
Practice Address - Street 1:46 AVENUE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49037-8374
Practice Address - Country:US
Practice Address - Phone:269-420-8665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010829231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP23230Medicare UPIN