Individual
KANDIS KOREEN DESHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
710 KENMOOR AVE SE STE 200, GRAND RAPIDS, MI 49546-2379
(616) 588-7246
Mailing address
205 ALPINE ST, WAYLAND, MI 49348-1232
(616) 885-7155
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801093338
MI
1041C0700X
Clinical Social Worker
6801093338
MI
Other
Enumeration date
01/03/2012
Last updated
03/06/2019
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