| NPI | 1093092140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER POTHOOF Billing 616-224-7617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801093691) |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2011-11-03 |