| Heather Duthler | |
|
648 Kinney Ave Nw Grand Rapids MI 49534 | |
| (616) 889-9098 | |
| Not Available |
| Full Name | Heather Duthler |
|---|---|
| Speciality | Social Worker |
| Location | 648 Kinney Ave Nw, Grand Rapids, Michigan |
| Authorized Official Name and Position | Heather E Duthler (PROVIDER) |
| Authorized Official Contact | 6168899098 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heather Duthler 648 Kinney Ave Nw Grand Rapids MI 49534 Ph: (616) 889-9098 | Heather Duthler 648 Kinney Ave Nw Grand Rapids MI 49534 Ph: (616) 889-9098 |
| NPI Number | 1336792324 |
|---|---|
| Provider Enumeration Date | 07/19/2019 |
| Last Update Date | 12/18/2019 |
| Certification Date | 12/18/2019 |
| Medicare PECOS PAC ID | 5294183323 |
|---|---|
| Medicare Enrollment ID | O20231129002353 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336792324 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Heather Elizabeth Duthler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538551346 PECOS PAC ID: 2769759794 Enrollment ID: I20170523002350 |
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