Healthcare Provider Details

I. General information

NPI: 1396053443
Provider Name (Legal Business Name): KRISTINA LYNN HOEKSEMA LMSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E CAYUGA ST
BELLAIRE MI
49615-9768
US

IV. Provider business mailing address

PO BOX 860
BELLAIRE MI
49615-0860
US

V. Phone/Fax

Practice location:
  • Phone: 231-533-8008
  • Fax: 231-533-8008
Mailing address:
  • Phone: 231-533-8008
  • Fax: 231-533-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086894
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: