| D.a. Blodgett For Children | |
|
2172 Dean Lake Ave Ne Grand Rapids MI 49505-4444 | |
| (616) 451-2021 | |
| (616) 774-3842 |
| Full Name | D.a. Blodgett For Children |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2172 Dean Lake Ave Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Tammy Smith (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 6164512021 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| D.a. Blodgett For Children 2172 Dean Lake Ave Ne Grand Rapids MI 49505-4444 Ph: (616) 451-2021 | D.a. Blodgett For Children 2172 Dean Lake Ave Ne Grand Rapids MI 49505-4444 Ph: (616) 451-2021 |
| NPI Number | 1801929435 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 04/26/2023 |
| Certification Date | 04/26/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801929435 | NPI | - | NPPES |
| 3243343 | Medicaid | MI | |
| 4486650 | Medicaid | MI | |
| 4537919 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CB410201088 (Michigan) | Primary |
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