Provider Demographics
NPI:1295928869
Name:SONKSEN, LARRY LYNN (LMSW)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:LYNN
Last Name:SONKSEN
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 1:2020 RAYBROOK ST SE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7717
Mailing Address - Country:US
Mailing Address - Phone:616-942-8544
Mailing Address - Fax:616-942-8544
Practice Address - Street 1:2020 RAYBROOK ST SE
Practice Address - Street 2:SUITE 306
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7717
Practice Address - Country:US
Practice Address - Phone:616-942-8544
Practice Address - Fax:616-942-8544
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010072951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008928970OtherBC/BS OF MI
MI350026OtherMANAGED HEALTH NETWORK
MI350026OtherMANAGED HEALTH NETWORK