Provider Demographics
NPI:1255988838
Name:DEYOUNG, KIRI
Entity type:Individual
Prefix:
First Name:KIRI
Middle Name:
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 GRANDVILLE AVE SW APT 4
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4985
Mailing Address - Country:US
Mailing Address - Phone:616-706-6334
Mailing Address - Fax:
Practice Address - Street 1:878 GRANDVILLE AVE SW APT 4
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4985
Practice Address - Country:US
Practice Address - Phone:616-706-6334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management