Healthcare Provider Details

I. General information

NPI: 1073081758
Provider Name (Legal Business Name): SHARON DEPCINSKI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2018
Last Update Date: 11/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4070 LAKE DR SE STE 101
GRAND RAPIDS MI
49546-8294
US

IV. Provider business mailing address

1748 TAMARACK AVE NW
GRAND RAPIDS MI
49504-2861
US

V. Phone/Fax

Practice location:
  • Phone: 616-690-0640
  • Fax:
Mailing address:
  • Phone: 616-690-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON DEPCINSKI
Title or Position: LMSW
Credential: LMSW
Phone: 616-690-0640