Healthcare Provider Details

I. General information

NPI: 1033022983
Provider Name (Legal Business Name): REBEKAH WISNESKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BETTY ST NE
COMSTOCK PARK MI
49321-9116
US

IV. Provider business mailing address

750 GRACELAND ST NE
GRAND RAPIDS MI
49505-4258
US

V. Phone/Fax

Practice location:
  • Phone: 616-254-5100
  • Fax:
Mailing address:
  • Phone: 616-272-9469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801117504
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: