Healthcare Provider Details

I. General information

NPI: 1295004448
Provider Name (Legal Business Name): MICHAEL L JANKOWSKI LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 WEALTHY ST SE STE 205
GRAND RAPIDS MI
49506-1596
US

IV. Provider business mailing address

949 WEALTHY ST SE STE 205
GRAND RAPIDS MI
49506-1596
US

V. Phone/Fax

Practice location:
  • Phone: 616-446-7265
  • Fax:
Mailing address:
  • Phone: 616-446-7265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086452
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: