Healthcare Provider Details

I. General information

NPI: 1295943231
Provider Name (Legal Business Name): RUTH A SMITH LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 36TH ST SE
GRAND RAPIDS MI
49548-2339
US

IV. Provider business mailing address

585 JEWETT RD
MASON MI
48854-8729
US

V. Phone/Fax

Practice location:
  • Phone: 616-247-4580
  • Fax: 616-247-4590
Mailing address:
  • Phone: 517-676-5405
  • Fax: 517-676-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095660
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: