Basic Information
| Provider Information | |||||||||
| NPI: | 1235221185 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3621 S STATE ST | ||||||||
| Address2: | 700 KMS PLACE | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349362047 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2101 COMMONWEALTH | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481052969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005255188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 10/26/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 6301002516 | MI | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103T00000X | 6301002516 | MI | N | Behavioral Health & Social Service Providers | Psychologist | 103TB0200X | 6301002516 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | 6301002516 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC2200X | 6301002516 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TF0200X | 6301002516 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Forensic |
No ID Information.