Healthcare Provider Details

I. General information

NPI: 1447959820
Provider Name (Legal Business Name): HEIDI LYN WORKMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 LAKE DR SE STE 1
GRAND RAPIDS MI
49506-1673
US

IV. Provider business mailing address

4520 BRIDLEWOOD DR
HUDSONVILLE MI
49426-7442
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-6060
  • Fax:
Mailing address:
  • Phone: 616-570-7056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090494
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: