Healthcare Provider Details

I. General information

NPI: 1023474988
Provider Name (Legal Business Name): EMILY JANKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY BEHM LMSW

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 COMMERCE AVE SW
GRAND RAPIDS MI
49503-4101
US

IV. Provider business mailing address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

V. Phone/Fax

Practice location:
  • Phone: 616-258-7599
  • Fax: 616-222-4571
Mailing address:
  • Phone: 616-455-5000
  • Fax: 616-455-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801099067
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: