Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6801093104 | MI |
NPI | 1003245408 |
---|---|
Provider Name | Candy Mckenney |
First Address | Grand Rapids, MI 49548-6927 |
Second Address | Grand Rapids, MI 49548-6927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2013 |
Last Update Date | 06/11/2013 |