Healthcare Provider Details

I. General information

NPI: 1164099719
Provider Name (Legal Business Name): HALEY ANN WOLFGRAM LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 BURTON ST SE STE 301
GRAND RAPIDS MI
49546-4800
US

IV. Provider business mailing address

2460 BURTON ST SE STE 301
GRAND RAPIDS MI
49546-4800
US

V. Phone/Fax

Practice location:
  • Phone: 517-507-5892
  • Fax: 517-258-2951
Mailing address:
  • Phone: 517-507-5832
  • Fax: 517-258-2951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851109990
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801117150
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: