Healthcare Provider Details

I. General information

NPI: 1295359081
Provider Name (Legal Business Name): JONATHAN PAUL RINEHART LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 STATE ST SE
GRAND RAPIDS MI
49503-4312
US

IV. Provider business mailing address

311 STATE ST SE
GRAND RAPIDS MI
49503-4312
US

V. Phone/Fax

Practice location:
  • Phone: 616-514-3646
  • Fax:
Mailing address:
  • Phone: 616-514-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801105438
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: