Healthcare Provider Details

I. General information

NPI: 1255267993
Provider Name (Legal Business Name): BRITTNEY WADE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6147 28TH ST SE STE 14
GRAND RAPIDS MI
49546-6934
US

IV. Provider business mailing address

6147 28TH ST SE STE 14
GRAND RAPIDS MI
49546-6934
US

V. Phone/Fax

Practice location:
  • Phone: 616-207-3075
  • Fax:
Mailing address:
  • Phone: 616-207-3075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851121616
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: