Healthcare Provider Details

I. General information

NPI: 1437604717
Provider Name (Legal Business Name): DREW KINGSBURY MARTINI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 HAMILTON AVE NW
GRAND RAPIDS MI
49504-4218
US

IV. Provider business mailing address

1034 HAMILTON AVE NW
GRAND RAPIDS MI
49504-4218
US

V. Phone/Fax

Practice location:
  • Phone: 586-601-6482
  • Fax:
Mailing address:
  • Phone: 586-601-6482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095522
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: