Provider Demographics
NPI:1992972053
Name:KEENAN, STEPHANIE A (LMSW)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:A
Last Name:KEENAN
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 1:8781 S 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROTHBURY
Mailing Address - State:MI
Mailing Address - Zip Code:49452-8085
Mailing Address - Country:US
Mailing Address - Phone:231-740-7913
Mailing Address - Fax:
Practice Address - Street 1:794 PINE ST STE 220A
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-1020
Practice Address - Country:US
Practice Address - Phone:231-740-7913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010920031041C0700X
MI68020843531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical