Healthcare Provider Details

I. General information

NPI: 1295127918
Provider Name (Legal Business Name): JOANN CRUMM LMSW, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 FULLER AVE NE
GRAND RAPIDS MI
49503-1918
US

IV. Provider business mailing address

6449 10 MILE RD NE
ROCKFORD MI
49341-9567
US

V. Phone/Fax

Practice location:
  • Phone: 616-336-3909
  • Fax: 616-855-5271
Mailing address:
  • Phone: 616-336-3909
  • Fax: 616-855-5271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801065850
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: