Provider Demographics
NPI:1770584856
Name:VANBEEK, KENNETH WAYNE (MSW)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:WAYNE
Last Name:VANBEEK
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:829 FOREST HILL AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2387
Mailing Address - Country:US
Mailing Address - Phone:616-949-2410
Mailing Address - Fax:616-949-9948
Practice Address - Street 1:2680 LEONARD NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-224-1515
Practice Address - Fax:616-224-2070
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801032931104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker