Provider Demographics
NPI:1184982787
Name:VISKER, KURTIS STEVEN (LMSW)
Entity type:Individual
Prefix:
First Name:KURTIS
Middle Name:STEVEN
Last Name:VISKER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 ALEXANDER ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3301
Mailing Address - Country:US
Mailing Address - Phone:616-648-9532
Mailing Address - Fax:
Practice Address - Street 1:4127 EMBASSY DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2418
Practice Address - Country:US
Practice Address - Phone:616-264-3205
Practice Address - Fax:616-264-3201
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010918821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical