Healthcare Provider Details

I. General information

NPI: 1447897434
Provider Name (Legal Business Name): KATHERINE ELIZABETH MINKS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 LAKE EASTBROOK BLVD SE STE 120
GRAND RAPIDS MI
49546-5939
US

IV. Provider business mailing address

4676 THORNBERRY HILL CT NE
GRAND RAPIDS MI
49525-9489
US

V. Phone/Fax

Practice location:
  • Phone: 616-914-7310
  • Fax:
Mailing address:
  • Phone: 616-914-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6800199793
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: