Kenneth Paul Watson, QMHP, QIDP, SST

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

2715 S Townline Rd
Houghton Lake, MI 48629-9294

Phone

(231) 620-8319

Fax

(989) 366-9420

NPI assigned

Sep 4, 2024

Last updated

Sep 4, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1598590002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2715 S TOWNLINE RD",
            "city": "HOUGHTON LAKE",
            "state": "MI",
            "postal_code": "486299294",
            "telephone_number": "231-620-8319",
            "fax_number": "989-366-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2715 S TOWNLINE RD",
            "city": "HOUGHTON LAKE",
            "state": "MI",
            "postal_code": "486299294",
            "telephone_number": "231-620-8319",
            "fax_number": "989-366-9420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "KENNETH",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "QMHP, QIDP, SST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-04",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert J Vanoosterhout, MA,LLP,CSW
• Tia Vanwinkle
• Shanna Marie Voelker, OTR/L
• Wal-Mart Stores East LP (Walmart Pharmacy 10-2014)
• Wal-Mart Stores East, LP (Vision Center 30-2014)
• Julie Beth Weiss, LBSW
• David Wenzel
• Charles Edward West, MSW
• Michelle A Wolfe, PA

• Case Manager/Care Coordinator in Houghton Lake, MI
• Providers in Houghton Lake, MI by specialty
• Case Manager/Care Coordinator in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.