Provider Demographics
NPI:1417597824
Name:KREMNITZER, KYMBERLY
Entity type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:
Last Name:KREMNITZER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5662 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5836
Mailing Address - Country:US
Mailing Address - Phone:231-343-1266
Mailing Address - Fax:
Practice Address - Street 1:5662 HENRY ST
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-5836
Practice Address - Country:US
Practice Address - Phone:231-343-1266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI685511170811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical