Healthcare Provider Details

I. General information

NPI: 1023713732
Provider Name (Legal Business Name): MEGAN PERKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 EVERGREEN DR NE STE 210
GRAND RAPIDS MI
49525-9830
US

IV. Provider business mailing address

3333 EVERGREEN DR NE STE 210
GRAND RAPIDS MI
49525-9830
US

V. Phone/Fax

Practice location:
  • Phone: 616-600-2845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851110667
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: