MEDICARE: ANDREA WALCOTT

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	6801115159	MI

General Provider Information

NPI Number	:	1871962605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA WALCOTT

Provider Business Mailing Address
First Line	:	218 E 1ST AVE STE C
Second Line	:
City	:	MITCHELL
State	:	SD
Zip	:	57301-3467
Country	:	US
Telephone Number	:	616-626-1112
Fax Number	:

Provider Business Practice Location Address
First Line	:	1346 BALDWIN ST #13
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-5904
Country	:	US
Telephone Number	:	167-658-5856
Fax Number	:

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

Provider Enumeration Date	:	09/22/2015
Last Update Date	:	03/05/2026

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Directions to “ ANDREA WALCOTT ” Practice Location

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