Healthcare Provider Details

I. General information

NPI: 1396935441
Provider Name (Legal Business Name): MATHEW KLEMP LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 SHELDON BLVD SE YWCA COUNLSELING CENTER
GRAND RAPIDS MI
49503-4209
US

IV. Provider business mailing address

25 SHELDON BLVD SE YWCA COUNLSELING CENTER
GRAND RAPIDS MI
49503-4209
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-4652
  • Fax: 616-459-0392
Mailing address:
  • Phone: 616-459-4652
  • Fax: 616-459-0392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801088801
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: