Provider Demographics
NPI:1942652730
Name:VENEMA, STACEY (LMSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:VENEMA
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 1:9927 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9088
Mailing Address - Country:US
Mailing Address - Phone:269-375-4363
Mailing Address - Fax:
Practice Address - Street 1:1090 N 10TH ST STE 110
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5733
Practice Address - Country:US
Practice Address - Phone:269-375-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801096148104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker