Healthcare Provider Details

I. General information

NPI: 1992189344
Provider Name (Legal Business Name): ANNE GRUBER-BARTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5270 NORTHLAND DR NE STE B
GRAND RAPIDS MI
49525-1073
US

IV. Provider business mailing address

701 HAYES DR
BAY CITY MI
48708-6801
US

V. Phone/Fax

Practice location:
  • Phone: 616-326-5672
  • Fax:
Mailing address:
  • Phone: 720-939-9089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCSW00001976
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801100685
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: