Healthcare Provider Details

I. General information

NPI: 1386836294
Provider Name (Legal Business Name): COURTNEY RENE CINGLIE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY RENE RUOFF LLMSW

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 BALL AVE NE
GRAND RAPIDS MI
49505-5904
US

IV. Provider business mailing address

1115 BALL AVENUE NE
GRAND RAPIDS MI
49505-4304
US

V. Phone/Fax

Practice location:
  • Phone: 616-495-7215
  • Fax: 616-451-0020
Mailing address:
  • Phone: 616-495-7215
  • Fax: 616-451-9929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086216
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: