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6230 Kalamazoo Ave Se Kentwood MI 49508-7022 | |
| (616) 754-6185 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 6230 Kalamazoo Ave Se, Kentwood, Michigan |
| Authorized Official Name and Position | Elisabeth Lacey (CREDENTIALING MANAGER) |
| Authorized Official Contact | 6164866630 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
100 Michigan St Ne # Mc845 Grand Rapids MI 49503-2560 Ph: () - | 6230 Kalamazoo Ave Se Kentwood MI 49508-7022 Ph: (616) 754-6185 |
| NPI Number | 1700470283 |
|---|---|
| Provider Enumeration Date | 02/24/2021 |
| Last Update Date | 10/31/2023 |
| Certification Date | 10/31/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700470283 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
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