MEDICARE: TESS PARKER MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	6801097860	MI

General Provider Information

NPI Number	:	1417367954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESS PARKER MSW

Provider Business Mailing Address
First Line	:	4778 WESTSHIRE DR NW
Second Line	:
City	:	COMSTOCK PARK
State	:	MI
Zip	:	49321-9363
Country	:	US
Telephone Number	:	303-859-8199
Fax Number	:

Provider Business Practice Location Address
First Line	:	385 LEONARD ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503
Country	:	US
Telephone Number	:	303-859-8199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	07/20/2018

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Directions to “ TESS PARKER MSW” Practice Location

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