Provider Demographics
NPI:1124466982
Name:VEENSTRA, KENNETH JAMES (LLMSW)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JAMES
Last Name:VEENSTRA
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3281 INMAN ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1028
Mailing Address - Country:US
Mailing Address - Phone:248-840-7611
Mailing Address - Fax:
Practice Address - Street 1:3281 INMAN ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1028
Practice Address - Country:US
Practice Address - Phone:248-840-7611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089612104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker