Provider Demographics
NPI:1942974043
Name:DE HAAN, KRISTEN WINTER (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:WINTER
Last Name:DE HAAN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:STEPHANIE
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:848 PEMBROKE ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-6015
Mailing Address - Country:US
Mailing Address - Phone:847-400-4689
Mailing Address - Fax:
Practice Address - Street 1:445 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3750
Practice Address - Country:US
Practice Address - Phone:269-488-5460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851104338104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker