Healthcare Provider Details

I. General information

NPI: 1043832595
Provider Name (Legal Business Name): KIRSTEN NICOLE RAHN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 5 MILE RD NE
GRAND RAPIDS MI
49525-6518
US

IV. Provider business mailing address

4625 PORTER HOLLOW DR NE
ROCKFORD MI
49341-8430
US

V. Phone/Fax

Practice location:
  • Phone: 616-426-9159
  • Fax:
Mailing address:
  • Phone: 248-709-4817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114886
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: