Provider Demographics
NPI:1962453548
Name:HOLWERDA, KIMBERLY ANNE-HANSEN (MA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE-HANSEN
Last Name:HOLWERDA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1293 MONTE CARLO DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8301
Mailing Address - Country:US
Mailing Address - Phone:616-667-2705
Mailing Address - Fax:616-667-2705
Practice Address - Street 1:1836 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8901
Practice Address - Country:US
Practice Address - Phone:616-457-0016
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL136241103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling