Healthcare Provider Details

I. General information

NPI: 1467709345
Provider Name (Legal Business Name): ELIZABETH ANN HESS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10047 CROSSROAD CT SE
CALEDONIA MI
49316-7316
US

IV. Provider business mailing address

PO BOX 776974
CHICAGO IL
60677-6974
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-8850
  • Fax: 616-891-9494
Mailing address:
  • Phone: 231-672-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086006
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: