Provider Demographics
NPI:1689964397
Name:NAYLOR, KOURTNEE JO (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KOURTNEE
Middle Name:JO
Last Name:NAYLOR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KOURTNEE
Other - Middle Name:JO
Other - Last Name:VANDYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-728-1663
Mailing Address - Fax:231-727-4571
Practice Address - Street 1:2006 HOLTON RD
Practice Address - Street 2:
Practice Address - City:NORTH MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-1505
Practice Address - Country:US
Practice Address - Phone:231-672-3333
Practice Address - Fax:231-672-6526
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801090826104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689964397Medicaid