Provider Demographics
NPI:1649379678
Name:KERWICK, NANETTE JUNE (LMSW CAADC)
Entity type:Individual
Prefix:
First Name:NANETTE
Middle Name:JUNE
Last Name:KERWICK
Suffix:
Gender:F
Credentials:LMSW CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 LEONARD ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-5515
Mailing Address - Country:US
Mailing Address - Phone:616-954-1991
Mailing Address - Fax:616-954-1998
Practice Address - Street 1:1400 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5515
Practice Address - Country:US
Practice Address - Phone:616-954-1992
Practice Address - Fax:616-954-1998
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801016614104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOD16262040Medicare ID - Type Unspecified